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

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.

Nursing Care of Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Case Study of Dermatology Unit of Referral Hospital, Kenya

“…In Guinea, mortality was 9.09% and 53.85% for SJS and in the case of TEN respectively in a total of 39 cases reported in a study [11]. Since the occurrence of HIV, the risk of cutaneous drug reactions is reported higher in patients with HIV than in the general population associated with some of the drugs in HAART, the treatment regimen proposed for HIV treatment in sub Saharan Africa [12]. The drug mainly nevirapine, was reportedly implicated in TEN with fatal outcome in pregnant women having received it in the context of preventing mother to child transmission of HIV [12].…”

“…Since the occurrence of HIV, the risk of cutaneous drug reactions is reported higher in patients with HIV than in the general population associated with some of the drugs in HAART, the treatment regimen proposed for HIV treatment in sub Saharan Africa [12]. The drug mainly nevirapine, was reportedly implicated in TEN with fatal outcome in pregnant women having received it in the context of preventing mother to child transmission of HIV [12]. Eepidemiology and incidence of SJS/TEN in Kenya is not very clear, although HIV infection is an endemic condition in this country with estimated prevalence of 4.9% [13], the role of HIV in epidemiology of SJS/TEN in Kenya cannot be underestimated.…”