Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa: a multicentric study in four countries

Int J Dermatol. 2013 May;52(5):575-9. doi: 10.1111/j.1365-4632.2012.05743.x. Epub 2013 Jan 20.

Abstract

Objective: The purpose of this study was to document the clinical profile, etiologies, and outcomes of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in hospitals in four sub-Saharan African countries.

Patients and methods: A retrospective study on cases of SJS/TEN treated in dermatology departments and/or intensive care units in four sub-Saharan African countries (Benin, Burkina Faso, Central African Republic, and Togo) from 2000 to 2010. The study focuses on variables such as age, sex, type of SJS/TEN, epidermal detachment of the skin surface, HIV status, drug(s) involved, and outcomes (death and sequelae).

Results: This study identified 177 cases of SJS/TEN from 2000 to 2010: 129 with SJS; 37 TEN; and 11 overlapping SJS/TEN. The average age of patients was 32.3 ± 15.4 years, and the sex ratio (M/F) was 0.6. HIV serology was positive in 69 (54.8%) of the 126 patients tested. Antibacterial sulfonamides (38.4%) were the most commonly used drugs followed by nevirapine (19.8%) and tuberculosis drugs (5.6%). We recorded 22 deaths (i.e. six cases of SJS, 15 of TEN, and one of overlapping SJS/TEN). Of the 22 patients who died, 16 were infected with HIV; among them, seven had an opportunistic infection (four cases of cerebral toxoplasmosis and three of pulmonary tuberculosis). Twenty-seven cases of sequelae were noted with a large part of eye complications.

Conclusion: This study has highlighted: (i) the high proportion of patients infected with HIV among patients who had SJS/TEN in sub-Saharan Africa; (ii) the high frequency of antiretroviral drugs as new SJS/TEN causes in sub-Saharan Africa; and (iii) the impact of HIV infection on morbidity and mortality of these affections.

Publication types

  • Multicenter Study

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / adverse effects*
  • Anti-HIV Agents / adverse effects*
  • Antitubercular Agents / adverse effects*
  • Brain Diseases / drug therapy
  • Child
  • Child, Preschool
  • Eye Diseases / etiology
  • Female
  • HIV Seropositivity / complications
  • HIV Seropositivity / drug therapy*
  • Humans
  • Infant
  • Length of Stay
  • Male
  • Middle Aged
  • Nevirapine / adverse effects
  • Retrospective Studies
  • Stevens-Johnson Syndrome / complications
  • Stevens-Johnson Syndrome / etiology*
  • Sulfonamides / adverse effects
  • Toxoplasmosis, Cerebral / drug therapy
  • Tuberculosis, Pulmonary / drug therapy
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Anti-HIV Agents
  • Antitubercular Agents
  • Sulfonamides
  • Nevirapine