Skip to main content
Top
Published in: American Journal of Clinical Dermatology 1/2012

01-02-2012 | Short Communication

Incidence of Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome in an HIV Cohort

An Observational, Retrospective Case Series Study

Authors: Nicole Mittmann, Sandra R. Knowles, Ms. Marika Koo, Neil H. Shear, Anita Rachlis, Sean B. Rourke

Published in: American Journal of Clinical Dermatology | Issue 1/2012

Login to get access

Abstract

Background: The incidence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) has been reported to be between 0.95 and 1 per 1000 individuals with AIDS. Accessibility to a cohort of individuals with HIV with known drug exposure (including drug, dose, and time of exposure) and collection of adverse-event information may provide an opportunity to determine an incidence rate of SJS and TEN.
Objective: The primary objective of this analysis was to determine the incidence of confirmed SJS and TEN in a cohort of Canadian HIV patients who were receiving HIV and HIV-related medications.
Study Design: This was a retrospective analysis of an HIV cohort.
Patient Population: The Ontario HIV Treatment Network (OHTN) cohort population was eligible for this analysis.
Methods: A search of the OHTN database was conducted to determine whether cases with a diagnosis of SJS or TEN were included. Search terms included ‘TEN,’ ‘SJS,’ ‘epidermal necrolysis,’ and ‘erythema multiforme.’ All SJS and TEN cases recorded in the OHTN database between January 1995 and August 2008 were obtained. Diagnostic criteria for SJS and TEN were established and two reviewers examined the medical records to confirm the SJS or TEN diagnosis. Drug exposure and utilization were documented. Incidence rates for the entire cohort were calculated.
Results: Seventeen cases over seven OHTN study sites were identified from an approximate cohort sample size of 3700. There were 15 men (88%). The mean ±SD age was 51.6 ± 11.3 years and time since HIV diagnosis was 16.1 ± 4.4 years. Only one patient reported experiencing a previous SJS or TEN episode. Of the 17 cases, clinical experts diagnosed five cases as true SJS and/or TEN, two cases were labeled as indeterminant, and the remaining cases were considered not SJS or TEN. Among the confirmed cases, drugs taken included nevirapine, trimethoprim/sulfamethoxazole (cotrimoxazole), stavudine (d4T), and clarithromycin.
Conclusions: The incidence of SJS and/or TEN was 5–7 per 3710 or approximately 1–2 per 1000 individuals in this cohort with HIV. Careful diagnosis of this adverse event is required for an accurate measure of incidence and to avoid false inflation of the incidence.
Literature
1.
go back to reference Fritsch PO, Ruiz-Maldonado R. Stevens-Johnson syndrome-toxic epidermal necrolysis. In: Freedberg IM, Eisen AZ, Wolff K, et al., editors. Fitzpatrick’s dermatology in general medicine. 5th ed. Toronto (ON): McGraw-Hill, 1999: 644–50 Fritsch PO, Ruiz-Maldonado R. Stevens-Johnson syndrome-toxic epidermal necrolysis. In: Freedberg IM, Eisen AZ, Wolff K, et al., editors. Fitzpatrick’s dermatology in general medicine. 5th ed. Toronto (ON): McGraw-Hill, 1999: 644–50
2.
go back to reference Bastuji-Garin S, Rzany B, Stern RS, et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol 1993; 129 (1): 92–6PubMedCrossRef Bastuji-Garin S, Rzany B, Stern RS, et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol 1993; 129 (1): 92–6PubMedCrossRef
3.
go back to reference Roujeau JC, Chosidow O, Saiag P, et al. Toxic epidermal necrolysis (Lyell syndrome). J Am Acad Dermatol 1990; 23 (6 Pt 1): 1039–58PubMedCrossRef Roujeau JC, Chosidow O, Saiag P, et al. Toxic epidermal necrolysis (Lyell syndrome). J Am Acad Dermatol 1990; 23 (6 Pt 1): 1039–58PubMedCrossRef
4.
go back to reference Schopf E, Stuhmer A, Rzany B, et al. Toxic epidermal necrolysis and Stevens- Johnson syndrome: an epidemiologic study from West Germany. Arch Dermatol 1991; 127 (6): 839–42PubMedCrossRef Schopf E, Stuhmer A, Rzany B, et al. Toxic epidermal necrolysis and Stevens- Johnson syndrome: an epidemiologic study from West Germany. Arch Dermatol 1991; 127 (6): 839–42PubMedCrossRef
5.
go back to reference Naldi L, Locati F, Marchesi L, et al. Incidence of toxic epidermal necrolysis in Italy. Arch Dermatol 1990; 126 (8): 1103–4PubMedCrossRef Naldi L, Locati F, Marchesi L, et al. Incidence of toxic epidermal necrolysis in Italy. Arch Dermatol 1990; 126 (8): 1103–4PubMedCrossRef
6.
go back to reference Chan HL, Stern RS, Arndt KA, et al. The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis: a populationbased study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol 1990; 126 (1): 43–7PubMedCrossRef Chan HL, Stern RS, Arndt KA, et al. The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis: a populationbased study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol 1990; 126 (1): 43–7PubMedCrossRef
7.
go back to reference Mittmann N, Chan B, Knowles S, et al. Intravenous immunoglobulin use in patients with toxic epidermal necrolysis and Stevens-Johnson syndrome. Am J Clin Dermatol 2006; 7 (6): 359–68PubMedCrossRef Mittmann N, Chan B, Knowles S, et al. Intravenous immunoglobulin use in patients with toxic epidermal necrolysis and Stevens-Johnson syndrome. Am J Clin Dermatol 2006; 7 (6): 359–68PubMedCrossRef
8.
go back to reference Revuz J, Penso D, Roujeau JC, et al. Toxic epidermal necrolysis: clinical findings and prognosis factors in 87 patients. Arch Dermatol 1987; 123 (9): 1160–5 Revuz J, Penso D, Roujeau JC, et al. Toxic epidermal necrolysis: clinical findings and prognosis factors in 87 patients. Arch Dermatol 1987; 123 (9): 1160–5
9.
go back to reference Schneck J, Fagot JP, Sekula P, et al. Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective study on patients including the prospective EuroSCAR study. J Am Acad Dermatol 2008; 58 (1): 33–40PubMedCrossRef Schneck J, Fagot JP, Sekula P, et al. Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective study on patients including the prospective EuroSCAR study. J Am Acad Dermatol 2008; 58 (1): 33–40PubMedCrossRef
10.
go back to reference Rzany B, Mockenhaupt M, Baur S, et al. Epidemiology of erythema exsudativum multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis in Germany (1990-1992): structure and results of a population-based registry. J Clin Epidemiol 1996; 49 (7): 769–73PubMedCrossRef Rzany B, Mockenhaupt M, Baur S, et al. Epidemiology of erythema exsudativum multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis in Germany (1990-1992): structure and results of a population-based registry. J Clin Epidemiol 1996; 49 (7): 769–73PubMedCrossRef
11.
go back to reference Dan M, Jedwab M, Peled M, et al. Allopurinol-induced toxic epidermal necrolysis. Int J Dermatol 1984; 23 (2): 142–4PubMedCrossRef Dan M, Jedwab M, Peled M, et al. Allopurinol-induced toxic epidermal necrolysis. Int J Dermatol 1984; 23 (2): 142–4PubMedCrossRef
12.
go back to reference Halevy S, Ghislain PD, Mockenhaupt M, et al. Allopurinol is the most common Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. J Am Acad Dermatol 2008; 58: 25–32PubMedCrossRef Halevy S, Ghislain PD, Mockenhaupt M, et al. Allopurinol is the most common Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. J Am Acad Dermatol 2008; 58: 25–32PubMedCrossRef
13.
go back to reference Carroll OM, Bryan PA, Robinson RJ. Stevens-Johnson syndrome associated with long-acting sulfonamides. JAMA 1966; 195 (8): 691–3PubMedCrossRef Carroll OM, Bryan PA, Robinson RJ. Stevens-Johnson syndrome associated with long-acting sulfonamides. JAMA 1966; 195 (8): 691–3PubMedCrossRef
14.
15.
go back to reference Aguiar D, Pazo R, Duran I, et al. Toxic epidermal necrolysis in patients recieving anticonvulsants and cranial irradiation: a risk to consider. J Neurooncol 2004; 66 (3): 345–50PubMedCrossRef Aguiar D, Pazo R, Duran I, et al. Toxic epidermal necrolysis in patients recieving anticonvulsants and cranial irradiation: a risk to consider. J Neurooncol 2004; 66 (3): 345–50PubMedCrossRef
16.
go back to reference Teraki Y, Shibuya M, Izaki S. Stevens-Johnson syndrome and toxic epidermal necrolysis due to anticonvulsants share certain clinical and laboratory featureswith drug-induced hypersensitivity syndrome, despite difference in cutaneous presentations. Clin Exp Dermatol 2009; 35 (7): 723–8CrossRef Teraki Y, Shibuya M, Izaki S. Stevens-Johnson syndrome and toxic epidermal necrolysis due to anticonvulsants share certain clinical and laboratory featureswith drug-induced hypersensitivity syndrome, despite difference in cutaneous presentations. Clin Exp Dermatol 2009; 35 (7): 723–8CrossRef
17.
go back to reference Ward KE, Archambault R, Mersfelder TL. Severe adverse skin reactions to nonsteroidal antiinflammatory drugs: a review of the literature. Am J Health Syst Pharm 2010; 67 (3): 206–13PubMedCrossRef Ward KE, Archambault R, Mersfelder TL. Severe adverse skin reactions to nonsteroidal antiinflammatory drugs: a review of the literature. Am J Health Syst Pharm 2010; 67 (3): 206–13PubMedCrossRef
18.
go back to reference Mockenhaupt M, Kelly JP, Kaufman D, et al. The risk of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with nonsteroidal antiinflammatory drugs: as multinational perspective. J Rheumatol 2003; 30 (10): 2234–40PubMed Mockenhaupt M, Kelly JP, Kaufman D, et al. The risk of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with nonsteroidal antiinflammatory drugs: as multinational perspective. J Rheumatol 2003; 30 (10): 2234–40PubMed
19.
go back to reference Vinod KS, Sethuraman G, Minz A. Stevens-Johnson syndrome, toxic epidermal necrolysis and SJS-TEN overlap: a retrospective study of causative drugs and clinical outcome. Indian J Dermatol Venereol Leprol 2008; 74 (3): 238–40CrossRef Vinod KS, Sethuraman G, Minz A. Stevens-Johnson syndrome, toxic epidermal necrolysis and SJS-TEN overlap: a retrospective study of causative drugs and clinical outcome. Indian J Dermatol Venereol Leprol 2008; 74 (3): 238–40CrossRef
20.
go back to reference Mockenhaupt M, Viboud C, Dunant A, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol 2008; 128 (1): 35–44PubMedCrossRef Mockenhaupt M, Viboud C, Dunant A, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol 2008; 128 (1): 35–44PubMedCrossRef
21.
go back to reference Roujeau JC, Kelly JP, Naldi L, et al. Medication use and the risk of Stevens- Johnson syndrome or toxic epidermal necrolysis. N Engl J Med 1995; 333 (24): 1600–7PubMedCrossRef Roujeau JC, Kelly JP, Naldi L, et al. Medication use and the risk of Stevens- Johnson syndrome or toxic epidermal necrolysis. N Engl J Med 1995; 333 (24): 1600–7PubMedCrossRef
22.
go back to reference Rzany B, Mockenhaupt M, Stocker U, et al. Incidence of Stevens-Johnson syndrome and toxic epidermal necrolysis in patients with the acquired immunodeficiency syndrome in Germany [letter]. Arch Dermatol 1993; 129 (8): 1059PubMedCrossRef Rzany B, Mockenhaupt M, Stocker U, et al. Incidence of Stevens-Johnson syndrome and toxic epidermal necrolysis in patients with the acquired immunodeficiency syndrome in Germany [letter]. Arch Dermatol 1993; 129 (8): 1059PubMedCrossRef
23.
go back to reference Saiag P, Caumes E, Chosidow O, et al. Drug-induced toxic epidermal necrolysis (Lyell syndrome) in patients infected with the human immunodeficiencey virus. J Am Acad Dermatol 1992; 26 (4): 567–74PubMedCrossRef Saiag P, Caumes E, Chosidow O, et al. Drug-induced toxic epidermal necrolysis (Lyell syndrome) in patients infected with the human immunodeficiencey virus. J Am Acad Dermatol 1992; 26 (4): 567–74PubMedCrossRef
24.
go back to reference Carr A, Tindall B, Penny R, et al. Patterns of multiple-drug hypersensitivities in HIV-infected patients. AIDS 1993; 7 (11): 1532–3PubMed Carr A, Tindall B, Penny R, et al. Patterns of multiple-drug hypersensitivities in HIV-infected patients. AIDS 1993; 7 (11): 1532–3PubMed
25.
go back to reference Rotunda A, Hirsch RJ, Scheinfeld N, et al. Severe cutaneous reactions associated with the use of human immundeficiency virus medications. Acta Derm Venereol 2003; 83 (1): 1–9PubMedCrossRef Rotunda A, Hirsch RJ, Scheinfeld N, et al. Severe cutaneous reactions associated with the use of human immundeficiency virus medications. Acta Derm Venereol 2003; 83 (1): 1–9PubMedCrossRef
26.
go back to reference Metry DW, Lahart CJ, Farmer KL, et al. Stevens-Johnson syndrome caused by the antiretroviral drug nevirapine. J Am Acad Dermatol 2001; 44 (2 Suppl.): 354–7PubMedCrossRef Metry DW, Lahart CJ, Farmer KL, et al. Stevens-Johnson syndrome caused by the antiretroviral drug nevirapine. J Am Acad Dermatol 2001; 44 (2 Suppl.): 354–7PubMedCrossRef
27.
go back to reference Warren KJ, Boxwell DE, Kim NY, et al. Nevirapine-associated Stevens- Johnson syndrome [letter]. Lancet 1998; 351 (9102): 567PubMedCrossRef Warren KJ, Boxwell DE, Kim NY, et al. Nevirapine-associated Stevens- Johnson syndrome [letter]. Lancet 1998; 351 (9102): 567PubMedCrossRef
28.
go back to reference Bastuji-Garin S, Fouchard N, Bertochhi M, et al. SCORTEN: a severity-ofillness score for toxic epidermal necrolysis. J Invest Dermatol 2000; 115: 149–53PubMedCrossRef Bastuji-Garin S, Fouchard N, Bertochhi M, et al. SCORTEN: a severity-ofillness score for toxic epidermal necrolysis. J Invest Dermatol 2000; 115: 149–53PubMedCrossRef
Metadata
Title
Incidence of Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome in an HIV Cohort
An Observational, Retrospective Case Series Study
Authors
Nicole Mittmann
Sandra R. Knowles
Ms. Marika Koo
Neil H. Shear
Anita Rachlis
Sean B. Rourke
Publication date
01-02-2012
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 1/2012
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.2165/11593240-000000000-00000

Other articles of this Issue 1/2012

American Journal of Clinical Dermatology 1/2012 Go to the issue

Review Article

Body Piercing