Share This Article:

Lyell Syndrome with Fatal Outcome in Two Pregnant Women Receiving Antiretroviral Therapy in Guinea Conakry

Abstract Full-Text HTML XML Download Download as PDF (Size:298KB) PP. 135-138
DOI: 10.4236/jcdsa.2013.32021    3,016 Downloads   4,501 Views   Citations

ABSTRACT

An old woman, 28 years old, weighing 74 kg was referred for skin detachment associated with bubbles and mucosal erosions. This clinical picture had occurred 15 days after the institution of a triple combination: AZT (300 mg) + 3TC (150 mg) and nevirapine (200 mg), during a pregnancy of 20-week gestation. The woman was in her third gestation. The second case is aged 26, weighing 65 kg. This clinical picture had occurred 20 days after the administration of a triple therapy combination: AZT (300 mg) + 3TC (150 mg) and nevirapine (200 mg), during a pregnancy of 32-week gestation. It was the fourth gestation. The birth of a stillborn had occurred the day before his admission into our service. The diagnosis of Toxic Epidermal Necrolysis with nevirapine was selected on the basis of the clinical and anamnestic arguments. The biological tests showed the following results: transaminases (ALT and AST) were within normal limits, blood glucose, and urea > 10 mmol/l. The evolution was marked by the patient death to Day 9 (D9) and at D2 of hospitalization. Discussion: NET and the SJS have been reported in pregnant women as potentially dangerous complications that are often associated with suspected drugs. Among these drugs, antiretroviral drugs, prescribed to pregnant women to prevent mother to child transmission of HIV are often reported. Our case is an illustration of the problem of HIV management in pregnant women. It also focuses on the association between pregnancy and Toxic Epidermal Necrolysis. Nevirapine is an effective drug in the regimens proposed in the management of HIV patients in limited resources countries. But the high frequency of toxidermia with this drug should lead to its replacement by other antiretrovirals least providers of toxidermia as anti proteases in the context of PMTCT programs.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

M. Cissé, M. Soumah, T. Tounkara, B. Diané, F. Sack, H. Baldé, A. Camara, A. Camara and A. Doumbouya, "Lyell Syndrome with Fatal Outcome in Two Pregnant Women Receiving Antiretroviral Therapy in Guinea Conakry," Journal of Cosmetics, Dermatological Sciences and Applications, Vol. 3 No. 2, 2013, pp. 135-138. doi: 10.4236/jcdsa.2013.32021.

References

[1] A. Lyell, “Toxic Epidermal Necrolysis: An Eruption Resembling Scalding of the Skin,” British Journal of Dermatology, Vol. 68, No. 11, 1956, pp. 355-361. doi:10.1111/j.1365-2133.1956.tb12766.x
[2] S. A. Coopman, R. Johnson, R. Platt, et al., “Cutaneous Diseases and Drug Reactions in HIV Infection,” The New England Journal of Medicine, Vol. 328, No. 23, 1993, pp. 1670-1674.
[3] A. Carr, C. Swanson, R. Penny, et al., “Clinical and Laboratory Markers of Hypersensitivity to TrimethoprimSulfamethoxazole in Patients with Pneumocystis Carinii Pneumonia and AIDS,” The Journal of Infectious Diseases, Vol. 167, No. 1, 1993, pp. 180-185. doi:10.1093/infdis/167.1.180
[4] A. Carr, B. Tindall and D. A. Cooper, “Patterns of Multiple Drug Hypersensitivity in HIV-Infected Patients,” AIDS, Vol. 7, No. 11, 1993, pp. 1532-1533. doi:10.1097/00002030-199311000-00023
[5] B. Milpied-Homsi, V. Relliquet, A. Huart, et al., “Skin Toxicity of Nevirapine Used as First-Line Treatment 100 Patients,” Annales de Dermatologie et de Venereologie, Vol. 126, 1999, p. 2S21.
[6] D. Halvir, S. H. Cheeseman, M. McLaughlin, et al., “High-Dose Nevirapine: Safety, Pharmacokinetics and Antiretroviral Effect in Patients with HIV,” The Journal of Infectious Diseases, Vol. 171, No. 3, 1995, pp. 537-545. doi:10.1093/infdis/171.3.537
[7] J. P. Fagot, M. Mockenhaupt, J. N. Bouwes-Bavinck, et al., “Nevirapine and the Risk of Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis,” AIDS, Vol. 15, No. 14, 2001, pp. 1843-1848. doi:10.1097/00002030-200109280-00014
[8] R. T. d’Aquilla, M. D. Hughes, V. A. Jonhson, et al., “Nevirapine, Zidovudine, and Didanosine Compared with Zidovudine and Didanosine in Patients with HIV-1 Infection,” Annals of Internal Medicine, Vol. 124, No. 12, 1996, pp. 1019-1030. doi:10.7326/0003-4819-124-12-199606150-00001
[9] A. Barner and M. Myers, “Nevirapine and Rashes,” Lancet, Vol. 351 , No. 9109, 1998, pp. 1133-1134. doi:10.1016/S0140-6736(05)79417-4
[10] B. Diatta, F. F. D. Ly, N. F. Ngom, C. T. Cissé, F. Fall, et al., “Toxidermia with Névirapine during Pregnancy about 3 Cases Report,” Annales de Dermatologie et de Venereologie, Vol. 138, No. C50, 2011, p. S54.
[11] A. Shilad, M. Predanic, S. C. Perni, et al., “Human Immunodeficiency Virus, Pregnancy and Stevens-Johnson Syndrome,” Obstetrics & Gynecology, Vol. 105, No. 5, 2005, pp. 1254-1256. doi:10.1097/01.AOG.0000157766.49494.99
[12] I. C. Niemeijer, M. C. Van Praag and N. Van Gemund, “Relevance and Consequences of Erythema Multiforme, Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Gynecology,” Archives of Gynecology and Obstetrics, Vol. 280, No. 5, 2009, pp. 851-854. doi:10.1007/s00404-009-1008-1
[13] K. Kratzert, F. Marks, C. Antoine, et al., “Pregnancy Post Stevens-Johnson Syndrome: Case Report and Review of the Literature,” Obstetrics & Gynecology, Vol. 72, No. 3, 1988, pp. 447-450.
[14] W. H. Chung, S. I. Hung, J. Y. Yang, et al., “Granulysin is a Key Mediator for Disseminated Keratinocyte Death in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis,” Nature Medicine, Vol. 14, No. 12, 2008, pp. 1343-1350. doi:10.1038/nm.1884
[15] N. Claessens, L. Delbeke, J. Lambert, et al., “Toxic Epidermal Necrolysis Associated with Treatment for Preterm Labor,” Dermatology, Vol. 196, No. 4, 1998, pp. 461-462. doi:10.1159/000017950
[16] M. F. Struck, T. Liss, Y. Illert, et al., “Toxic Epidermal Necrolysis in Pregnancy: Case Report and Review of the Literature,” Journal of Burn Care & Research, Vol. 31, No. 5, 2010, pp. 816-821. doi:10.1097/BCR.0b013e3181eed441
[17] R. B. Pollard, P. Robinson and K. Dransfield, “Safety Profile of Nevirapine a Nonnucleosid Reverse Transcriptase Inhibitor for the Treatment of HIV,” Clinical Therapeutics, Vol. 20, No. 6, 1998, pp. 1071-1092. doi:10.1016/S0149-2918(98)80105-7
[18] H. Knobel, J. M. Miro, P. Domingo, et al., “Failure of Short-Term Prednisone Regimen to Prevent Nevirapine Associated Rash: Double-Blind Placebo-Controlled Trial, the GESIDA09/99 Study,” Journal of Acquired Immune Deficiency Syndromes, Vol. 28, No. 1, 2001, pp. 14-18.
[19] A. Carr, S. Vella, MD. de Jong et al., “A Controlled Trial of Nevirapine Plus Zidovudine alone in p24 Antigenaemic HIV-Infected Patients. The Dutch-Italian-Australian Nevirapine Study Group,” AIDS, Vol. 10, No. 6, 1996, pp. 635-641. doi:10.1097/00002030-199606000-00009
[20] J. S. Montaner, P. Reiss, D. A. Cooper, et al., “A Randomized, Double Blind Trial Comparing Combinaisons of Nevirapine, Didanosine and Zidovudine for Hivinfected Patients: The INCAS Trial,” JAMA, Vol. 279, No. 12, 1998, 930-937. doi:10.1001/jama.279.12.930
[21] F. Lawson-Ayayi, R. Thiebaut, R. Ramanampamonjy, et al., “A Cohort of Nevirapine Tolerance in Clinical Practice: French Aquitaine Cohort 1997-1999,” Clinical Infectious Diseases, Vol. 35, No. 10, 2002, pp. 1231-1237. doi:10.1086/343046
[22] E. Caumes, P. Bossi, C. Katlama, et al., “Antiretroviral Drug Eruption to Patients Infected with HIV,” La Presse Médicale, Vol. 32, No. 28, 2003, pp. 1325-1333.
[23] A. Rotunda, R. J. Hirsch, N. Scheinfeld, et al., “Severe Cutaneous Reactions Associated with the Use of Human Immunodeficiency Virus Medications,” Acta DermatoVenereologica, Vol. 83, No. 1, 2003, pp. 1-9. doi:10.1080/00015550310002611
[24] Y. Bourezane, D. Salard, B. Hoen, et al., “DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) Syndrome Associated with Nevirapine Therapy,” Clinical Infectious Diseases, Vol. 27, No. 5, 1998, pp. 1321-1322.
[25] V. Kohlbrenner, K. Dansfield, V. Cotton, et al., “Cutaneous Eruptions Associated with Nevirapine Therapy in HIV-1 Infected Patients Individuals (Abstract MoB 12021),” 10th International Conference on AIDS, Vancouver, 7-12 July 1996, p. 607.
[26] J. S. Montaner, P. Cahn, C. Zala, et al., “Randomized, Controlled Study of the Effects of Short Course of Prednisone on the Incidence of Rash Associated Nevirapine in Patients Infected with HIV-1,” Journal of Acquired Immune Deficiency Syndromes, Vol. 33, No. 1, 2003, pp. 41-46. doi:10.1097/00126334-200305010-00007
[27] S. J. Bersoff-Matcha, W. C. Miller, J. A. Aberg, et al., “Sex Differences in Nevirapine Rash,” Clinical Infectious Diseases, Vol. 32, No. 1, 2001, pp. 124-129. doi:10.1086/317536
[28] P. Brocklehurst and R. French, “The Association between Maternal HIV Infection and Perinatal Outcome: A Systematic Review of the Literature and Meta-Analysis,” British Journal of Obstetrics and Gynaecology, Vol. 105, No. 8, 1998, pp. 836-848. doi:10.1111/j.1471-0528.1998.tb10227.x
[29] European Collaborative Study, “Swiss Mother and Child Cohort Study: Combination Antiretroviral Therapy and Duration of Pregnancy,” AIDS, Vol. 14, No. 18, 2000, pp. 2913-2920. doi:10.1097/00002030-200012220-00013
[30] E. G. Szyld, E. M. Warley, L. Freimanis, et al., “Maternal Antiretroviral Drugs during Pregnancy and Infant Low Birth Weight and Preterm Birth,” AIDS, Vol. 20, No. 18, 2006, pp. 2345-2353. doi:10.1097/01.aids.0000253362.01696.9d
[31] A. M. Cotter, A. G. Garcia, M. L. Duthely, et al., “Is Antiretroviral Therapy during Pregnancy Associated with an Increased Risk of Preterm Delivery, Low Birth Weight, or Stillbirth?” The Journal of Infectious Diseases, Vol. 193, No. 9, 2006, 1195-1201. doi:10.1086/503045

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.