The disease is characterised by cutaneous eruption which can take on any morphology, fever, lympadenopathy and the presence of eosinophilia or atypical lymphocytes and solid organ inflammation on laboratory investigation. Common end organs affected include the heart, lung, kidneys and liver. Mortality approaches 20% if untreated, usually as a result of hepatotoxicity. (143)
The diagnosis is usually clinical, and may be aided by the REGISCAR scoring system. (147) Skin biopsies usually reflect the morphology of the cutaneous eruption but are not specific to DRESS. The eosinophilia may be delayed, developing days after the first skin signs are noted.
Identification and cessation of the causative medication is paramount. High dose corticosteroids, eg prednisolone 1mg/kg/day are the cornerstone of treatment. This is usually tapered over a period of 6-12 weeks. Guidelines do not suggest differing treatment for DRESS in PLWHIV. Following the acute phase, DRESS patients are at risk of autoimmune sequelae such as diabetes …
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are part of the spectrum of SCAR. The incidence is higher in patients with HIV infection than in the general population due to higher rates of polypharmacy and underlying immune dysregulation. (149, 150) There have been well documented case reports of Stevens- Johnson syndrome and TEN in …
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) Read More »
Patients with SJS/TEN may present with a prodrome of fever, stinging eyes, painful swallowing, followed by development of dusky macules which progress to erosions and bullae. Epidermal detachment is common, which may lead to massive fluid loss and electrolyte imbalance. Any mucosal surface may be affected including the eyes, aerodigestive tract and genitalia. SJS is …
A skin biopsy is usually obtained for definitive diagnosis given the morbidity and mortality associated with this condition. Severity scoring such as with the SCORTEN criteria may be helpful for prognostication. (153)
Stevens-Johnson syndrome has an attributable mortality of 5% and TEN an overall mortality of 30%. (153) If SJS/TEN is considered, patients should be transferred to a tertiary centre, and ideally one with an HDU/ICU or Burns Unit. Discontinuation of the offending drug is essential. Drugs initiated in the last 1 to 3 weeks before illness …
Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nature reviews Disease primers. 2015;1(1):1-22. Hogan MT. Cutaneous infections associated with HIV/AIDS. Dermatologic clinics. 2006;24(4):473-95. Veenstra J, Krol A, van Praag RME, Frissen PMJ, Schellekens PTA, Lange JMA, et al. Herpes zoster, immunological deterioration and disease progression in HIV-1 infection. Aids. 1995;9(10):1153-8. Strick LB, Wald …
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