Stevens - Johnson syndrome due to nevirapine

Area of Science:

• Infectious Diseases
• Pharmacovigilance
• Dermatology

Background:

• Antiretroviral therapy (ART) is crucial for managing HIV infection.
• Nevirapine (NVP) is a non-nucleoside reverse transcriptase inhibitor used in ART regimens.
• Hormonal contraception use in HIV-infected women requires careful consideration of drug interactions and side effects.

Observation:

• A 25-year-old HIV-infected woman on ART (Combivir & Nevirapine) developed a mild rash, conjunctivitis, pharyngitis, and fever on day 12 of treatment.
• The patient's condition progressed to a generalized erythematous eruption, leading to admission and diagnosis of Stevens-Johnson syndrome (SJS).

Findings:

• Nevirapine (NVP) was identified as the likely cause of Stevens-Johnson syndrome (SJS) in this HIV-infected patient.
• Discontinuation of Nevirapine (NVP) led to the patient's clinical improvement and recovery from SJS.
• The patient was subsequently able to tolerate an alternative ART regimen (Combivir and Efavirenz) without adverse events.

Implications:

• This case highlights the potential for severe cutaneous adverse reactions, such as SJS, associated with Nevirapine (NVP) use.
• Early recognition and prompt discontinuation of the offending agent are critical for managing drug-induced SJS.
• Alternative antiretroviral (ARV) drug choices are essential for patients who experience severe adverse reactions to specific medications.