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

Antoinette V. Chateau, Ncoza C. Dlova, Halima Dawood, Colleen Aldous
Southern African Journal of HIV Medicine | Vol 20, No 1 | a944 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.944 | © 2019 Antoinette Vanessa Chateau, Ncoza Cordelia Dlova, Halima Dawood, Colleen Aldous | This work is licensed under CC Attribution 4.0
Submitted: 21 January 2019 | Published: 04 July 2019

About the author(s)

Antoinette V. Chateau, Department of Dermatology, School of Clinical Medicine Greys Hospital, University of Kwa-Zulu Natal, KwaZulu-Natal, South Africa
Ncoza C. Dlova, Department of Dermatology, School of Clinical Medicine Greys Hospital, University of Kwa-Zulu Natal, KwaZulu-Natal, South Africa
Halima Dawood, Department Medicine, Infectious Disease Unit, Greys Hospital and Caprisa, University of Kwa-Zulu Natal, KwaZulu-Natal, South Africa
Colleen Aldous, Department of General Medicine, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa


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Abstract

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe life-threatening mucocutaneous reactions. There is an ongoing controversy regarding the use of systemic corticosteroids and intravenous immunoglobulin (IVIG) in SJS/TEN and their utility in HIV-infected patients.

Objectives: The objective was to assess the outcome of a combination of intensive supportive care with oral corticosteroids in SJS and a combination of systemic steroids and IVIG for 3 consecutive days in HIV-infected patients with TEN. In addition, we assessed management in a general dermatology ward without implementing wound debridement.

Methods: This was a retrospective cohort study of 36 HIV-infected adults with SJS/TEN admitted to a tertiary dermatology unit between 1st January 2010 and 31st July 2011. Standard-of-care protocols included identification and elimination of the possible causative drug, meticulous wound care without debridement, initiation of oral prednisone (1 mg/kg/day) on admission for 3 consecutive days, and the addition of IVIG (1 g/kg/day) for 3 consecutive days to those with TEN.

Results: Of the 36 patients in the study, 32 were female. Nevirapine was the commonest drug implicated. A diagnosis of tuberculosis did not increase the case fatality rate. Complications included infections, anaemia, drug-induced hepatitis, ocular involvement, renal impairment, deep vein thrombosis, respiratory distress, Leucopenia, gastritis and hypernatremia. The overall survival rate was 97%.

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 respectively had a survival rate of 97%.


Keywords

Stevens–Johnson syndrome; Toxic epidermal necrolysis; Systemic steroids; Intravenous immunoglobulins

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