A Comparative Insight into the Incidence of Steven Johnson Syndrome/ Toxic Epidermal Necrolyis among the Immunocompromized Patient Populace of Eastern India with a Distinctive Emphasis on the Possible Association of Human Cytomegalovirus

Abstract

Stevens-Johnson syndrome (SJS) and its more advanced form, Toxic Epidermal Necrolysis (TEN) are severe adverse cutaneous reactions that predominantly involve skin and mucous membranes. In view of the current dearth of documented knowledge, this study the first of its kind from India was designed to categorically distinguish and compare the different associated factors and clinical manifestations relevant to the development of SJS/TEN syndrome among the immunocompromised (Human Immunodeficiency Virus 1 seropositive) patients in Eastern India. 16 out of 29 patients (55.1%) were found to be suffering from drug induced SJS or TEN, while the rest (44.8%) had severe pathogenic involvements. Neviraprine use was found to be the major cause among drug involved SJS (53.8%) and TEN (66.66%) cases followed by allopurinol use. The frequency of incidence of kidney disease (67% in SJS and 54% in TEN) and neurological impairment (42% SJS and 37%TEN) was found to be significantly higher among the SJS patients whereas that of hepatitis (38% SJS and 47% TEN) , ocular dysfunction (49% SJS and 63% TEN) and pulmonary dysfunction (47% SJS and 53% TEN) were higher among the TEN patients. This study also had another prominent motive, which is to elucidate the possible role of human cytomegalovirus in triggering the exfoliative inflammatory disease conditions among these patients. The incidence rate of SGPT and SGOT were significantly higher in TEN patients than in SJS (p=0.001 and p=0.002) . Mean sodium level in blood was within normal range in both the groups whereas potassium and chloride levels were much higher than normal Out of the 29 HIV seropositive patients with SJS/TEN we studied, only 4 (13.7%) had an active HCMV infection. In detailed study of the associated laboratory and clinical parameters, cytokine analysis profile, Immuno-histologic findings and rigorous analysis of the investigation reports identified HCMV infection as the probable trigger behind SJS/TEN development in these patients.