Severe eye complications from toxic epidermal necrolysis following initiation of Nevirapine based HAART regimen in a child with HIV infection: a case from Cameroon

Abstract

BackgroundToxic epidermal necrolysis (TEN) is a rare life threatening dermatological disorder characterized by extensive epidermal detachment and erosion of mucous membranes. It is typically a side effect of some medications. Nevirapine, a nonnucleoside reverse transcriptase inhibitor (NNRTI) is one of the frequently used components of highly active antiretroviral therapy (HAART). Skin rash is its common adverse reaction, usually mild and rarely progressing to TEN. Ophthalmic involvement is common as well but rarely progresses to blindness especially in the pediatric population.Case presentationWe report the case of a 3 year 5 month old child diagnosed with HIV who developed TEN 8 days after starting a Nevirapine based HAART regimen. Drug withdrawal and supportive treatment alone were the modalities employed to achieve complete re-epithelization of lesions. Patient was lost to follow-up 6 months after being in care and was only seen 3 years later with total loss of vision.ConclusionBlindness, though rare, can be a long-term complication of TEN in children especially with HIV infection. Physicians and patient caregivers should closely monitor these patients, especially during their early stages of treatment amongst others for development of adverse drug reactions. Long-term retention in care is pivotal for identification and prompt management of ocular and other chronic complications, albeit recognizing management challenges in low resourced settings.

Antiretroviral Drugs in African Surface Waters: Prevalence, Analysis, and Potential Remediation

“…TEN is characterized by severe cutaneous adverse reaction (SCAR) characterized by extensive detachment of the epidermis and mucous membranes, which could potentially lead to blindness in children (Thammakumpee et al 2013). However, the World Health Organization (WHO) recommends efavirenz and nevirapine as highly active antiretroviral therapy (HAART) for low-income countries due to their low cost, efficacy, and easy accessibility (Tchetnya et al 2018).…”

“…Toxic epidermal necrolysis, or Lyell's syndrome, is a rare idiosyncratic life‐threatening side effect of nevirapine administered to infants diagnosed with HIV infection (Tchetnya et al 2018). Toxic epidermal necrolysis is characterized by severe cutaneous adverse reaction characterized by extensive detachment of the epidermis and mucous membranes, which could potentially lead to blindness in children (Thammakumpee and Yongsiri 2013).…”

Highly Active Antiretroviral Therapy Induced Hematological and Dermatological Adverse Drug Reactions in People Living with HIV in India

“…This predominance was probably because a higher number of patients of this age group [87 (50%)] were admitted for HIV disease treatment during the study period. However, other studies (31)(32)(33) have reported a higher percentage of ADRs to HAART in geriatric and pediatric HIV-carrying populations.…”

Nevirapine-induced Stevens-Johnson syndrome in children living with HIV in South Africa

“…3 We accessed nine reports of SJS/TEN in children exposed to NVP describing 29 patients in total. 6,7,8,9,10,11,12,13,14 Although NVP hypersensitivity has been associated with higher CD4 cell counts in adults (> 250 cells/μL in females and > 400 cells/μL in males), the above case reports show SJS and TEN occurring at any stage of immune suppression in paediatric populations. 8 It has been suggested that the paucity of cases reporting on the association between NVP in children and SJS/TEN may be a result of prescribing behaviour rather than an actual decreased risk compared with adults.…”