Clostridium difficile Diarrhea After Use of Tacrolimus

sive use, none of the nucleoside analogues used to treat our patients if gynecomastia is another feature of the syndrome of HIV-1 prote(zidovudine, lamivudine, or stavudine) have been associated with ase inhibitor–associated peripheral lipodystrophy. gynecomastia, whereas indinavir has already been described as a cause of breast enlargement in women. One of the patients we Juan-Pablo Caeiro, Fehmida Visnegarwala, described and the two previously reported women with indinavirand Maria C. Rodriguez-Barradas associated breast enlargement developed redistribution of body fat, Section of Infectious Diseases and Medical Service, Veterans Affairs a feature of the syndrome of peripheral fat wasting (lipodystrophy), Medical Center, and Department of Medicine, Baylor College of hyperlipidemia, and insulin resistance that has been recently deMedicine, Houston, Texas scribed in patients who received HIV-1 protease inhibitors [1]. One of our patients had associated lipid abnormalities; repeated References fasting blood glucose levels have remained within normal limits. 1. Carr A, Samaras K, Chisholm DJ, Cooper DA. Pathogenesis of HIV-1Gynecomastia is a benign glandular enlargement of the male protease inhibitor-associated peripheral lipodystrophy, hyperlipidaemia, breast. This entity has been associated with the use of various and insulin resistance. Lancet 1998;352:1881–3. drugs including anabolic steroids; antimicrobials (isoniazid, keto2. Visnegarwala F, Krause KL, Musher DM. Severe diabetes associated with conazole, metronidazole); cardiovascular, antiulcer, and psychoprotease inhibitor therapy [letter]. Ann Intern Med 1997;127:947. active medications; and certain chemotherapeutic agents [6]. 3. Wong-Beringer A, Beringer P, Lovett MA. Hypertrophy of the breasts in Breast enlargement, although uncommon, should be included a patient treated with indinavir. Clin Infect Dis 1997;25:937. among the adverse effects associated with use of protease inhibi4. Lui A, Karter D, Turett G. Another case of breast hypertrophy in a patient tors in both men and women. The mechanism for this side effect treated with indinavir [letter]. Clin Infect Dis 1998;26:1482. is unknown, but does not appear to be associated with any obvious 5. Couderc LJ, Clauvel JP. HIV-infection-induced gynecomastia [letter]. Ann endocrine abnormalities. Whether this effect is exclusively due to Intern Med 1987;107:257. 6. Braunstein GD. Gynecomastia. N Engl J Med 1993;328:490–5. indinavir is a matter of speculation, and it remains to be determined