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
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 patien...
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| Format: | Article |
| Language: | English |
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AOSIS
2019-07-01
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| Series: | Southern African Journal of HIV Medicine |
| Subjects: | |
| Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/944 |
| _version_ | 1818007498424057856 |
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| author | Antoinette V. Chateau Ncoza C. Dlova Halima Dawood Colleen Aldous |
| author_facet | Antoinette V. Chateau Ncoza C. Dlova Halima Dawood Colleen Aldous |
| author_sort | Antoinette V. Chateau |
| collection | DOAJ |
| description | 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%. |
| first_indexed | 2024-04-14T05:16:23Z |
| format | Article |
| id | doaj.art-36ad8825ae1945148cd314fa3e6f8c09 |
| institution | Directory Open Access Journal |
| issn | 1608-9693 2078-6751 |
| language | English |
| last_indexed | 2024-04-14T05:16:23Z |
| publishDate | 2019-07-01 |
| publisher | AOSIS |
| record_format | Article |
| series | Southern African Journal of HIV Medicine |
| spelling | doaj.art-36ad8825ae1945148cd314fa3e6f8c092022-12-22T02:10:21ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512019-07-01201e1e810.4102/sajhivmed.v20i1.944638Outcomes of Stevens–Johnson syndrome and toxic epidermal necrolysis in HIV-infected patients when using systemic steroids and/or intravenous immunoglobulins in Pietermaritzburg, South AfricaAntoinette V. Chateau0Ncoza C. Dlova1Halima Dawood2Colleen Aldous3Department of Dermatology, School of Clinical Medicine Greys Hospital, University of Kwa-Zulu Natal, KwaZulu-NatalDepartment of Dermatology, School of Clinical Medicine Greys Hospital, University of Kwa-Zulu Natal, KwaZulu-NatalDepartment Medicine, Infectious Disease Unit, Greys Hospital and Caprisa, University of Kwa-Zulu Natal, KwaZulu-NatalDepartment of General Medicine, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-NatalBackground: 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%.https://sajhivmed.org.za/index.php/hivmed/article/view/944Stevens–Johnson syndromeToxic epidermal necrolysisSystemic steroidsIntravenous immunoglobulins |
| spellingShingle | Antoinette V. Chateau Ncoza C. Dlova Halima Dawood Colleen Aldous 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 Southern African Journal of HIV Medicine Stevens–Johnson syndrome Toxic epidermal necrolysis Systemic steroids Intravenous immunoglobulins |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Stevens–Johnson syndrome Toxic epidermal necrolysis Systemic steroids Intravenous immunoglobulins |
| url | https://sajhivmed.org.za/index.php/hivmed/article/view/944 |
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