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- Title
Toxic epidermal necrolysis and Stevens–Johnson syndrome in South Africa: a 3-year prospective study.
- Authors
Kannenberg, S.M.H.; Jordaan, H.F.; Koegelenberg, C.F.N.; Von Groote-Bidlingmaier, F.; Visser, W.I.
- Abstract
Background: 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.Aim: 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.Methods: 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.Results: 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 < 0.001). A SCORTEN &geq;2 on Days 1 and 3 predicted non-survival (OR = 2.94, P = 0.047; OR = 7.45, P < 0.001). Other predictors of non-survival included HIV infection (OR = 6.01, P = 0.058), HIV–tuberculosis co-infection (OR = 8.5, P < 0.001), &geq;40% skin involvement (OR = 20.27, P < 0.001), anaemia (OR = 4.68, P = 0.005), hypoalbuminemia (OR = 8.5, P = 0.001) and severe sepsis (OR = 71.09, P < 0.001).Conclusions: Most patients with TEN/SJS were HIV positive and female. We validated the use of SCORTEN and identified several prognostic indicators, most significant being HIV-tuberculosis co-infection, &geq;40% skin involvement and severe sepsis.
- Subjects
SOUTH Africa; TOXIC epidermal necrolysis; STEVENS-Johnson Syndrome; HIV infections; SEPSIS; TUBERCULOSIS; LONGITUDINAL method
- Publication
QJM: An International Journal of Medicine, 2012, Vol 105, Issue 9, p839
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hcs078