Stevens-Johnson syndrome and toxic epidermal necrolysis in Lome (Togo).: Evolutional and etiological profiles of 40 cases.

Introduction. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous drug reactions, the prognosis of which largely depends on the quality of their treatment. The purpose of this study was to determine the evolutional and etiological profiles of SJS/TEN in a teaching hospital in Lome (Togo). Methods. The medical records of patients hospitalized in the departments of dermatology and intensive care of the university hospital center of Lome for SJS/TEN from 1992 to 2001 were reviewed retrospectively. The records of patients retained corresponded to the international classification criteria of SJS/TEN. Results. We collected 40 cases of SJS/TEN (27 cases of SJS, 12 cases of TEN and one overlap SJS/TEN). Patients' mean age was of 30 +/- 7 years. The sex ratio (male/female) was of 1.5 and the mean follow-up after hospitalization was of 2 months (range: 4 weeks to 8 months). The HIV serology was known in 20 cases (13 cases of SJS and 7 cases of TEN). It was positive in 10 cases (5 during TEN and 5 during SJS). Five of the 12 patients (41.7 p.cent) exhibiting NET died (all were HIV-infected) versus 2 of the 27 patients (7-4 p.cent) exhibiting SJS (2 patients were also HIV-infected). The principle drugs incriminated were: antibacterial sulphonamides (16 cases; 40 p.cent), rifampicin-isoniazid combination (7 cases; 17.9 p.cent), anti-epileptics (5 cases; 12.5 p.cent); amino-penicillin (4 cases; lo p.cent) and non-steroidal anti-inflammatories (2 cases; 5 p.cent). Chinese drugs of undetermined nature were incriminated in 3 cases of SJS. No drug was formally identified in 3 cases of SJS. Discussion. This study confirms the rareness of SJS/NET. These affections are of poor prognosis, particularly in developing countries. The results of this study suggest that the concomitance of an opportunist infection due to HIV-immunodepression is of poor prognosis in the evolution of SJS/NET. Antibacterial sulphonamides and the rifampicin-isoniazid combination are frequently incriminated in Togo.