Toxic epidermal necrolysis and Stevens―Johnson syndrome in South Africa: a 3-year prospective study

Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) remain feared medication-related reactions. HIV infection and tuberculosis predispose to drug eruptions, yet there is a paucity of data on TEN/SJS in populations with high prevalences of both diseases. The aim of this prospective ob...

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Bibliographic Details
Published in:QJM : An International Journal of Medicine 2012-09, Vol.105 (9), p.839-846
Main Authors: KANNENBERG, S. M. H, JORDAAN, H. F, KOEGELENBERG, C. F. N, VON GROOTE-BIDLINGMAIER, F, VISSER, W. I
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Bullous diseases of the skin
Comorbidity
Dermatology
Female
General aspects
HIV Seropositivity - complications
HIV Seropositivity - mortality
Human immunodeficiency virus
Humans
Male
Medical sciences
Miscellaneous
Mycobacterium
Prognosis
Prospective Studies
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
South Africa - epidemiology
Stevens-Johnson Syndrome - chemically induced
Stevens-Johnson Syndrome - etiology
Stevens-Johnson Syndrome - mortality
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Summary:Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) remain feared medication-related reactions. HIV infection and tuberculosis predispose to drug eruptions, yet there is a paucity of data on TEN/SJS in populations with high prevalences of both diseases. The aim of this prospective observational study was to describe the features and outcomes of patients admitted with TEN/SJS at a large academic hospital in South Africa. We aimed to identify poor prognostic indicators and to validate the use of the TEN-specific severity-of-illness score (SCORTEN) in this population. All patients admitted with TEN/SJS over a 3-year period were enrolled. Disease severity was graded according to percentage skin involved and SCORTEN. Co-morbid diagnoses, clinical features, investigations, complications and outcomes were noted. 75 patients (39.9 ± 10.6 years, 16 males, 59 HIV positive) were classified as TEN (n  = 42), TEN/SJS overlap (n = 11) and SJS (n = 22). Twenty-four percent died, most from refractory septic shock. Non-survivors had a higher mean SCORTEN on Days 1 and 3 (1.89 vs. 1.04, P = 0.006 and 2.27 vs. 0.90, P 
ISSN:1460-2725
1460-2393
DOI:10.1093/qjmed/hcs078