Abstract
IntroductionStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug reactions with a higher incidence in HIV-infected persons. SJS/TEN are associated with skin and mucosal failure, predisposing to systemic bacterial infection (BSI), a major cause of death. There are limited data on risk factors associated with BSI and and mortality in HIV-infected people with SJS/TEN.MethodsWe conducted a retrospective study of patients admitted to a university hospital with SJS/TEN over a 3 year period. We evaluated their underlying illnesses, eliciting drugs, predictive value of bacterial skin cultures and other factors associated with mortality and BSI in a predominantly HIV-infected population by comparing characteristics of the patients who demised and those who survived.ResultsWe admitted 86 cases during the study period and 67/86(78%) were HIV-infected. Tuberculosis was the commonest co-morbidity, diagnosed in 12/86(14%) cases. Skin cultures correlated with BSI by the same organism in 7/64(11%) cases and 6/7 were Gram-negative. Two of the 8 cases of Gram-negative BSI had an associated Gram-negative skin culture, although not always the same organism. All 8 fatalities had >30% epidermal detachment, 7 were HIV-infected, 6 died of BSI and 6 had tuberculosis.ConclusionsHaving >30% epidermal detachment in SJS/TEN carries an increased risk of BSI and mortality. Tuberculosis and BSI are associated with higher risk of death in SJS/TEN. Our data suggests there may be an association between Gram-negative BSI and Gram-negative skin infection.
Highlights
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug reactions with a higher incidence in HIV-infected persons
Participants and data extraction We reviewed clinical records of consecutive patients admitted with SJS, TEN and SJS/TEN overlap to the dermatology ward from 1st January 2009 to 31st December 2011
Sixtyseven of the 86 (66%) cases were HIV-infected, with the median CD4 count amongst those being 137cells/mm3 (IQR 114 &291). Of these 68 only 28% were on antiretroviral therapy (ART)
Summary
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug reactions with a higher incidence in HIV-infected persons. SJS/TEN are associated with skin and mucosal failure, predisposing to systemic bacterial infection (BSI), a major cause of death. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), collectively known as Lyell’s syndrome, are rare lifethreatening cutaneous drug reactions with a reported combined incidence of approximately 0.05–3 cases/million per year, considerably higher in HIV-infected persons [1,2]. The skin failure is associated with loss of haemostatic function, fluid and electrolyte imbalance, metabolic abnormalities, impaired thermoregulation and loss barrier function allowing potential pathogens to gain access to the body predisposing to localised and bacterial systemic infection (BSI) [4]
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