Page 257 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Original Research

Outcomes of Stevens–Johnson syndrome and toxic

epidermal necrolysis in HIV-infected patients when using

systemic steroids and/or intravenous immunoglobulins

in Pietermaritzburg, South Africa

Authors: Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are
Antoinette V. Chateau 1 severe life-threatening mucocutaneous reactions. There is an ongoing controversy regarding
Ncoza C. Dlova
1
Halima Dawood 2 the use of systemic corticosteroids and intravenous immunoglobulin (IVIG) in SJS/TEN and
Colleen Aldous 3 their utility in HIV-infected patients.
Affiliations: Objectives: The objective was to assess the outcome of a combination of intensive supportive
1 Department of Dermatology, care with oral corticosteroids in SJS and a combination of systemic steroids and IVIG for 3
School of Clinical Medicine consecutive days in HIV-infected patients with TEN. In addition, we assessed management in
Greys Hospital, University
of Kwa-Zulu Natal, KwaZulu- a general dermatology ward without implementing wound debridement.
Natal, South Africa
Methods: This was a retrospective cohort study of 36 HIV-infected adults with SJS/TEN
2 Department Medicine, admitted to a tertiary dermatology unit between 1st January 2010 and 31st July 2011. Standard-
Infectious Disease Unit, of-care protocols included identification and elimination of the possible causative drug,
Greys Hospital and Caprisa, meticulous wound care without debridement, initiation of oral prednisone (1 mg/kg/day) on
University of Kwa-Zulu Natal, admission for 3 consecutive days, and the addition of IVIG (1 g/kg/day) for 3 consecutive
KwaZulu-Natal, South Africa
days to those with TEN.
3 Department of General
Medicine, School of Clinical Results: Of the 36 patients in the study, 32 were female. Nevirapine was the commonest drug
Medicine, University of implicated. A diagnosis of tuberculosis did not increase the case fatality rate. Complications
KwaZulu-Natal, KwaZulu- included infections, anaemia, drug-induced hepatitis, ocular involvement, renal impairment,
Natal, South Africa deep vein thrombosis, respiratory distress, Leucopenia, gastritis and hypernatremia. The

Corresponding author: overall survival rate was 97%.
Antoinette Chateau,
[email protected] Conclusion: HIV-infected SJS and TEN patients were treated in a tertiary dermatology ward
with a treatment plan of skin care, and a combination of systemic corticosteroids and IVIG
Dates: respectively had a survival rate of 97%.
Received: 21 Jan. 2019
Accepted: 13 Mar. 2019 Keywords: Stevens–Johnson syndrome; Toxic epidermal necrolysis; Systemic steroids;
Published: 04 July 2019 Intravenous immunoglobulins.

How to cite this article:
Chateau AV, Dlova NC,
Dawood H, Aldous C. Introduction
Outcomes of Stevens–Johnson
syndrome and toxic epidermal Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe life-threatening
1,2
necrolysis in HIV-infected mucocutaneous reactions characterised by epithelial sloughing and systemic symptoms.
patients when using systemic Stevens–Johnson syndrome is characterised by mucous membrane erosions and epidermal
steroids and/or intravenous detachment, which involves less than 10% of the body surface area (BSA) in the Bastuji-Garin
immunoglobulins in
Pietermaritzburg, South Africa. classification. Stevens–Johnson syndrome–toxic epidermal necrolysis overlap represents
3
S Afr J HIV Med. 2019;20(1), 10% – 30% BSA involvement, and TEN involves over 30% BSA involvement. The worldwide
a944. https://doi.org/10.4102/ incidence rate of SJS is 1.2–6 per million persons per year with a mortality rate of 5%, while
sajhivmed.v20i1.944 the incidence rate of TEN is 0.5–1.2 per million per year with a mortality rate of up to 30%. 4

In South Africa, there are no published data on the incidence of SJS and TEN. With the current
HIV epidemic and increased use of HIV treatment in South Africa, the number of patients with
SJS/TEN has increased. The incidence of SJS/TEN is 1000-fold higher in patients with HIV.
5
6
Read online: The high incidence of SJS/TEN in immunocompromised patients is likely multifactorial. It may
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Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 250 Open Access