Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Maternal and Foetal Outcomes in Twenty-Two Consecutive Pregnant HIV Infected Women

Abstract

IntroductionStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) form a spectrum of a rare and life-threatening cutaneous drug reaction. SJS/TEN in pregnancy poses largely unknown risk factors and outcomes for both the mother and foetus compared to the general population.MethodsWe conducted a study of consecutive pregnant women admitted to single tertiary referral centre in South Africa with SJS/TEN over a 3 year period. They were all managed by the same medical team using the same protocols. We evaluated their underlying illnesses, offending drugs and the course of pregnancy and outcomes to determine factors influencing maternal and foetal outcomes.ResultsWe identified twenty-two women who developed SJS/TEN while pregnant, all of them HIV-infected. Their median age was 29 years. The majority 16/22 (73%) had SJS, the milder variant of the disease affecting < 10% body surface area. Nevirapine was the offending drug in 21/22 (95%) cases. All 22 of the mothers survived with 3/22 (14%) developing postpartum sepsis. Pregnancy outcomes were known in 18/22 women and 9/18 (50%) babies were delivered by caesarean section. There were 2 foetal deaths at 21 and 31 weeks respectively and both were associated with post-partum sepsis. Postnatal complications occurred in 5 cases, 3 involving the respiratory system and the other two being low birth weight deliveries. Eight placentae and one foetus were sent for histology and none showed macroscopic or microscopic features of SJS/TEN. On follow-up, only 12/20 children were tested for HIV at 6 weeks post-delivery and none of them were HIV-infected. All had received prophylactic ARVs including nevirapine.ConclusionsTEN, the severe form of the disease, was associated with poorer foetal outcomes. SJS/TEN-associated mortality is not increased in HIV-infected pregnant women. Maternal SJS/TEN does not seem to commonly manifest in the foetus.

Stevens Johnson Syndrome and Toxic Epidermal Necrolysis Induced by Nevirapine among HIV-Infected Pregnant Women: Five Cases

“…The favorable outcome in all our patients could be related to the young age, the absence of factors of co morbidities, the stoppage of the ARV and the multidisciplinary early management (between dermatologist and obstetricians). We did not observe fetal complications to the type of prematurity that is reported by some authors [10][11][12]. Anti-proteases were used as a therapeutic alternative in the antiretroviral treatment protocol because nevirapine toxidermia is associated with a 10% cross-reactivity risk with efavirenz.…”

Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

“…In this study, examined placentas were normal clinically and histologically and the placenta to birth weight ratio, a predictor of pregnancy outcomes, was normal. The study concluded that maternal and fetal mortality was not increased and fetal manifestation of SJS/TEN was not the norm (125). However, other studies have suggested that TEN, the more severe form of the disease is associated with a higher risk of premature labor (126).…”

Risk factors for, and treatment of, Stevens-Johnson syndrome and toxic epidermal necrolysis: Evidence from the literature

“…Generally speaking, studies on the incidence and prevalence of SJS and TEN are undertaken in the developed countries (Knight et al, 2015). The difficulties related to the precise diagnosis of SJS and TEN may be related to underestimating the number of cases (Lim et al, 2016).…”