TITLE:
Lyell Syndrome with Fatal Outcome in Two Pregnant Women Receiving Antiretroviral Therapy in Guinea Conakry
AUTHORS:
Mohamed Cissé, Mohamed Maciré Soumah, Thierno Mamadou Tounkara, Boh Fanta Diané, Fodé Bangaly Sack, Houleymatou Baldé, Amara Camara, Aissata Dabo Camara, Alhousseini Doumbouya
KEYWORDS:
Lyell; Pregnant Women; Nevirapine; Fatal Outcome
JOURNAL NAME:
Journal of Cosmetics, Dermatological Sciences and Applications,
Vol.3 No.2,
June
7,
2013
ABSTRACT: An old woman, 28 years old, weighing
74 kg was referred for skin detachment associated with bubbles and mucosal erosions.
This clinical picture had occurred 15 days after the institution of a triple
combination: AZT (300 mg)
+ 3TC (150 mg) and nevirapine
(200 mg), during a
pregnancy of 20-week
gestation. The woman was in her third gestation. The second case is aged 26,
weighing 65 kg. This clinical picture had occurred 20 days after the administration of a triple
therapy combination: AZT (300 mg) + 3TC (150 mg) and nevirapine (200 mg),
during a pregnancy of 32-week gestation. It was the fourth gestation. The birth of a stillborn had
occurred the day before his admission into our service. The diagnosis of Toxic
Epidermal Necrolysis with nevirapine was selected on the basis of the clinical
and anamnestic arguments. The biological tests showed the following results:
transaminases (ALT and AST) were within normal limits, blood glucose, and urea > 10 mmol/l. The evolution was marked by the
patient death to Day 9 (D9) and at D2 of hospitalization. Discussion: NET and the SJS have been reported in pregnant women as
potentially dangerous complications that are often associated with suspected
drugs. Among these drugs, antiretroviral drugs, prescribed to pregnant women to
prevent mother to child transmission of HIV are often reported. Our case is an
illustration of the problem of HIV management in pregnant women. It also
focuses on the association between pregnancy and Toxic Epidermal Necrolysis.
Nevirapine is an effective drug in the regimens proposed in the management of
HIV patients in limited resources countries. But the high frequency of
toxidermia with this drug should lead to its replacement by other
antiretrovirals least providers of toxidermia as anti proteases in the context
of PMTCT programs.