Page 260 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 8 Original Research

isoniazid prophylaxis and the other eight to Rifafour®. Of continuum of the drug reactions with seven complications
these eight patients, only three were microbiologically noted in SJS patients, 19 in SJS-TEN overlap syndrome and
confirmed cases of tuberculosis. The three patients were 27 noted in the patients with TEN (Table 4). Ten patients
rechallenged with anti-tuberculosis therapy without (28.7%) were noted to have infections (Table 5).
further incident.
There was one death in our study representing a case fatality
The most common drugs implicated were nevirapine (69.4%), rate of 2.8%. The patient was pregnant (34 weeks gestation)
anti-tuberculosis medication (16.7%) and trimethoprim/ and was admitted with TEN secondary to nevirapine.
sulfamethoxazole (8.3%). Other drugs included phenytoin She had a CD4 count of 185 cells/mm and a SCORTEN score
3
(2.8%) and fluconazole (2.8%) (Table 3). of 4 which predicted a poor outcome (expected mortality rate
of 58.3%). She experienced preterm labour 2 days after
Thirty-two of the study patients had associated complications admission and gave birth to a stillborn male. She died 4 days
such as anaemia, drug-induced hepatitis, ocular involvement, after admission. She presented with poor prognostic factors:
renal impairment, deep vein thrombosis, respiratory distress, SCORTEN score of 4 (tachycardia, BSA involvement of 40%
lichen planus, Leucopenia, gastritis and hypernatremia. acidosis and elevated urea, as well as hypernatremia and
The number of complications noted increased along the Staphylococcus aureus septicaemia).
TABLE 3: CD4, SCORTEN, drugs implicated, co-morbidities and mortality of 36 HIV-infected patients presenting with Stevens–Johnson syndrome–toxic epidermal
necrolysis.
Variable Total (n = 36) SJS (n = 11) SJS/TEN (n = 13) TEN (n = 12)
n % Mean s.d. n % Mean s.d. n % Mean s.d. n % Mean s.d.
CD4 count (cells/mm ) 3 - - 236.8 146.8 - - 216.3 109.2 - - 270.5 194.8 - - 217.4 115.5
SCORTEN score
0-1 11 30.5 - - 11 30.5 - - 0 - - - 0 - - -
2 12 33.3 - - 0 - - - 8 22.2 - - 4 11.1 - -
3 9 25.0 - - 0 - - - 4 11.1 - - 5 13.9 - -
4 3 8.3 - - 0 - - - 1 2.8 - - 2 5.6 - -
5 1 2.8 - - 0 - - - 0 - - - 1 2.8 - -
Drugs used
NVP alone 15 41.7 - - 7 19.4 - - 3 8.3 - - 5 13.9 - -
NVP, D4T, 3TC/TMP/SMX 6 16.7 - - 1 2.8 - - 2 5.6 - - 3 8.3 - -
NVP, D4T, 3TC/Rifafour 2 5.6 - - 1 2.8 - - 0 - - - 1 2.8 - -
NVP, D4T, 3TC/INH 1 2.8 - - 0 - - - 1 2.8 - - 0 - - -
NVP, D4T, 3TC/INH/TMP/SMX 1 2.8 - - 0 - - - 1 2.8 - - 0 - - -
TMP/SMX 2 5.6 - - 1 2.8 - - 1 2.8 - - 0 - - -
TMP/SMX + phenytoin 1 2.8 - - 0 - - - 0 - - - 1 2.8 - -
TMP/SMX + Rifafour 3 8.3 - - 0 - - - 1 2.8 - - 2 5.6 - -
Rifafour 3 8.3 - - 1 2.8 - - 2 5.6 - - 0 - - -
Phenytoin 1 2.8 - - 0 - - - 0 - - - 1 2.8 - -
Fluconazole 1 2.8 - - 0 - - - 1 2.8 - - 0 - - -
Comorbidity
TB 8 22.2 - - 2 5.6 - - 3 8.3 - - 3 8.3 - -
Hypertension 2 5.6 - - 0 - - - 1 2.8 - - 1 2.8 - -
Epilepsy 2 5.6 - - 0 - - - 1 2.8 - - 1 2.8 - -
Mortality 1 2.8 - - 0 - - - 0 - - 1 2.8 - -

TABLE 4: Complications correlated to the various drug reactions.
Complications SJS SJS-TEN overlap TEN Total
n % n % n % n %
Infection 1 2.8 4 11.1 5 13.9 10 27.8
Anaemia 3 8.3 5 13.9 8 22.2 16 44.4
Drug-induced hepatitis 2 5.6 4 11.1 3 8.3 9 25
Deep vein thrombosis 0 - 0 - 2 5.6 2 5.6
Lichen planus 0 - 1 2.8 0 - 1 2.8
Ocular 1 2.8 4 11.1 3 8.3 8 22.2
Renal impairment 0 - 1 2.8 2 5.6 3 8.3
Hypernatraemia 0 - 0 - 1 2.8 1 2.8
Leucopenia 0 - 0 - 1 2.8 1 2.8
Acute respiratory distress syndrome 0 - 0 - 1 2.8 1 2.8
Gastritis and esophageal ulceration 0 - 0 - 1 2.8 1 2.8
Total 7 - 19 - 27 53 -
SJS, Stevens–Johnson syndrome; TEN, Toxic epidermal necrolysis; SJS-TEN overlap.

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