Stevens-Johnson syndrome and toxic epidermal necrolysis at Universitas Academic Hospital: a 4-year review
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Date
2021-11
Authors
Moosa, Fatima
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Publisher
University of the Free State
Abstract
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening dermatologic conditions that are part of the same disease spectrum. Drugs are the main inciting factor of this delayed (type IV) hypersensitivity reaction which produces epidermal and mucosal detachment. Despite morbidity and mortality being high, there are limited data available on SJS and TEN in South Africa. The objective of this study was to characterise patient demographics, aetiology and implicated drugs, treatment, and outcome in patients with SJS and TEN at a tertiary academic hospital in the Free State, South Africa. Methods: A retrospective, cross-sectional descriptive single centre study which included participants managed at Universitas Academic Hospital, South Africa between 2016 and 2020 was performed. Results: Fifty-five cases meeting the inclusion and exclusion criteria were included in this study. The cohort comprised TEN, SJS-TEN and SJS (n=40, n=10 and n=5 respectively). The mean age of the cohort was 37-years (range: 21- 67). Seventy percent were HIV-infected. Antibiotics (58%) and antiretroviral therapy (30%) were the most common drug classes implicated, with trimethoprim-sulfamethoxazole (22%) and nevirapine (16%) being identified as the most commonly implicated drugs. The major complication in the cohort was sepsis (42%). Supportive care formed the mainstay of treatment and the mortality rate was 14.5%. Conclusion: The majority of the patients in this cohort were HIV infected, with antiretroviral therapy (specifically nevirapine) and antibiotics (specifically trimethoprim-sulfamethoxazole, used for prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in the HIV-infected population) being commonly implicated causes of SJS and TEN. In resource-limited settings such as our facility, supportive care forms the predominant mode of treatment with a relatively good outcome.
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Dissertation (M.Med. (Dermatology))--University of the Free State, 2021, Cutaneous adverse drug reaction, Hypersensitivity reaction, South Africa, Stevens-Johnson syndrome, Toxic Epidermal Necrolysis