Stevens-Johnson syndrome associated with nevirapine use in an HIV-positive pregnant woman: a case report.

BACKGROUND

Stevens-Johnson syndrome (SJS) is a rare but potentially life threatening condition which has been associated with infections, neoplasm and drug use.

OBJECTIVE

To report a case of nevirapine-induced SJS in an HIV-positive pregnant woman on antiretroviral therapy for prevention of mother-to-child transmission (PMTCT) of HIV.

METHODS

Clinical and laboratory evaluation of a 31-year old HIV-positive primigravida who presented at 20 weeks gestation with fever and generalized skin rash with bullae. She was admitted and managed conservatively as a case of SJS.

RESULTS

There was history of use of nevirapine-containing highly active antiretroviral therapy (HAART) for six weeks prior to presentation. Physical findings included a generalized skin rash with bullae, oral mucosa blisters/ulcerations and purulent conjunctivitis. She was managed as a case of SJS. Antiretroviral drugs were temporarily withdrawn. A skin biopsy confirmed the diagnosis of a drug-induced dermatosis (erythema multiforme). She recovered satisfactorily with significant improvement of her dermatologic, oral mucosal and eye conditions and was discharged after 35 days of hospitalization. She was recommenced on antiretroviral therapy but with substitution of nevirapine in place of saquinavir. She carried the pregnancy to term and was delivered of a live baby through caesarean section.

CONCLUSION

Practitioners managing HIV-positive patients on nevirapine-containing antiretroviral therapy should be aware of the potential for SJS. A high index of suspicion is required to be able to promptly diagnose, refer and/or institute appropriate management to avoid severe morbidity and fatality associated with this condition.