Table 2.
Description of cases based on most probable culprit drug
| Possible causative drug n=62 | Number of cases | Causality score* | Mean Age (in years) | Gender (M=20, F=42) | Mean Latency period in days | Diagnosis | Remarks | |||
|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||
| SJS (n=26) | Overlap (n=15) | TEN (n=21) | ||||||||
| Anticonvulsants 23 (37.1%) | Phenytoin | 9 | Very probable | 29.3 | M=5 F=4 |
20 | 4 | 2 | 3 | Two patients each were also receiving carbamazepine and phenobarbitone |
| Carbamazepine | 9 | Very probable | 45.3 | M=2 F=7 |
21 | 5 | 1 | 3 | Two patients each were also receiving phenytoin and sodium valproate. | |
| Lamotrigine | 3 | Very probable | 24.5 | F=3 | 18 | 1 | 1 | 1 | Two patients were also taking sodium valproate | |
| Phenobarbitone | 2 | Very probable | 22.3 | M=1 F=1 |
19 | 1 | 1 | 0 | Both patients were also taking phenytoin | |
| DMARDs 16 (25.8%) | Allopurinol | 14 | Very probable | 60.2 | M=1 F=13 |
25 | 5 | 5 | 4 | Gout (n=1), CKD (n=1), Arthralgia (n=3) Physiological hyperuricemia (n=9) |
| Leflunomide | 1 | Very probable | 33 | F=1 | 45 | 1 | 0 | 0 | - | |
| Sulfasalazine | 1 | Very probable | 74 | M=1 | 21 | 0 | 1 | 0 | - | |
| ART 8 (12.9%) | Nevirapine | 7 | Very probable | 43.3 | M=4 F=3 |
13 | 3 | 3 | 1 | ART (SLN and ZLN regimens, n=2 each; TLN regimen, n=1). 2 SJS patients died; one of them developed TEN after he retook nevirapine mistakenly |
| Efavirenz | 1 | Very probable | 35 | M=1 | 10 | 1 | 0 | 0 | ART (TLE regimen) | |
| NSAIDs 5 (8.1%) | Paracetamol | 1 | Very probable | 38 | F=1 | 4 | 0 | 0 | 1 | One SJS patient had also taken ofloxacin and cefixime. Redeveloped TEN when took PCM again |
| Diclofenac sodium | 1 | Very probable | 60 | F=1 | 8 | 0 | 0 | 1 | PCM was other drug in combination. There was no history of drug reaction with PCM in the past | |
| Mefenamic acid | 1 | Probable | 10 | F=1 | 2 | 1 | 0 | 0 | None of them had received any other drug | |
| Lornoxicam | 1 | Probable | 68 | F=1 | 5 | 0 | 0 | 1 | ||
| Etoricoxb | 1 | Probable | 60 | F=1 | 20 | 1 | 0 | 0 | ||
| Antimicrobials 3 (4.8%) | Cotrimoxazole | 2 | Very probable | 47 | M=2 | 18 | 1 | 1 | 0 | Taken for Pneumocystis jiroveci prophylaxis prior to ART |
| Ethambutol HCl | 1 | Very probable | 38 | M=1 | 21 | 0 | 0 | 1 | Developed SJS after retaking ethambutol by mistake | |
| Antipsychotics 2 (3.2%) | Trihexyphenidyl | 2 | Very probable | 51.5 | M=1 F=1 |
19 | 0 | 0 | 2 | One patient re-took the drug and developed SJS |
| Unknown 5 (8.1%) | Indigenous | 5 | Probable | 32.0 | M=1 F=4 |
13 | 2 | 0 | 3 | One patient each treated for psychiatric illness, toothache, aches, PUO, and diarrhea |
*Causality assessment was based on World Health Organization-Uppsala Monitoring Centre (WHO-UMC) scale and algorithm of drug causality for epidermal necrolysis (ALDEN) score. Drug re-challenge was not performed in any of the patients. ART-, antiretroviral treatment; CKD, chronic kidney disease; DMARDs, disease-modifying anti-rheumatic drugs; F, female; HIV, human immunodeficiency virus; M, male; NSAIDs, non-steroidal anti-inflammatory drugs; PCM, paracetamol; PUO, pyrexia of unknown origin; SJS, Stevens-Johnson syndrome; SLN, stavudine + lamivudine + nevirapine; TEN, toxic epidermal necrolysis; TLE, tenofovir + lamivudine + efavirenz; TLN, tenofovir + lamivudine + nevirapine