Stevens-Johnson syndrome (SJS) is an immune complex hypersensitivity reaction of the human body due to many factors such us infections, drugs and malignancies. Eighty six years ago (1922) from first described by Stevens and Johnson, SJS have linked to the use of drugs rather than other caused factors. Nevirapine may also been linked in the pathogenesis of SJS. This article reported a case of severe Steven Johnson Syndrome.
With a 25 year old HIV-infected woman who participating in a study of hormonal therapy effects contraception on HIV progression, this woman was given on antiretroviral therapy Combivir and initial 200 mg daily of Nevirapine (NVP) for two weeks threreafter increased to 200 mg bid.
At day twelve, she showed a mild skin rash on the trunk, fever, pharyngitis and purulent conjunctivitis. The next day she presented with a generalized erythematous eruption then she was diagnosed with SJS. The suspect of its etiology is Nevirapine, so the antiretroviral was stopped. After having good recovery, she was administered on Combivir and Efavirenz and showed well with this regimen.
The process of this disease usually begins with a non specific upper respiratory tract infection, in a day 1 to 14 it may show fever sore throat, headache, and malaise. In previous study, it stated that most cases of SJS in HIV infected patients were corresponded to antibacterial sulphonamides and thiacetazone. A report from investigators said SJS occured in a mother and her eight year-old son who had therapy combination of Nevirapine with d4T and 3TC.
Everybody with antigens HLA (Human Leucosyte Antigen) Bw44, HLA B12, and HLA-DQB1*0601 reported to be more susceptible to have SJS, and it affects all ages either man or woman.
During prodromal period, vomiting and diarhea may occur. Then rash may develop macules then develop into papules, vesicles, bullae, or erythema. The complete Blood Count may be normal, but an elevated count may indicate a superimposed infection. May be need to have a renal function tests, electrolytes and any other chemistries.
Epidermal cell necrosis may be showed up and perivascular areas are infiltrated with lymphosytes. Overall, Stevens Johnsons Syndrome is a severe cutaneous disorder with characterized skin blisters and mucous membrane erosions. therefore, the treatment of this disease is supportive and simptomatic primarily. In therapy progression, the lession may heal in 1-2 weeks without superimposed infection. The patients may recover without sequelae.
As said in this medical journal, a clinician must have index of suspicion to be able to diagnose and treat patients with SJS for it because the critical of subsequent survival of the patients. If a patients have their therapy of an ART regiment contains Nevirapine, we must be careful and always suspect SJS if the patient is presenting symptoms like irritation of the skin and mucous membranes.
The author of this medical journal were G K Namayanja, J M Nankya, J K Byamugisha, F N Ssali, C M Kityo, SD Rwambuya, R D Mugerwa, F A Mmiro, C S Morrison, and RA Salata from Afr Health Sci. 2005 December; 5(4): 338–340 PMCID: PMC1831939 and Copyrighted by Makerere Medical School, Uganda 2005.
Download information : Full Text / PDF Format
