Oral manifestations of toxic epidermal necrolysis (TEN) in patients with AIDS: report of five cases.
OBJECTIVE
To describe oral findings in HIV-infected individuals with toxic epidermal necrolysis (TEN).


METHODS
In a retrospective study over a 10 year period the medical histories of 931 hospitalised HIV-infected patients were reviewed for the occurrence of TEN.


RESULTS
Five cases of TEN were diagnosed (three men, two women; median age: 41 years; median CD4+ T lymphocyte count: 20/microliter). Four patients had been treated with biweekly pyrimethamine/sulfadoxine for prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis. In one patient flucloxacillin was administered. Signs of TEN with cutaneous epidermolysis occurred and patients showed oral lesions characterized as oropharyngeal blisters and bullae on the palate, buccal mucosa, tongue and floor of the mouth initially. Antibiotics and corticosteroids were administered; none of the patients died.


CONCLUSIONS
Longacting sulfonamides and antibiotics have been implicated as the cause of severe mucocutaneous reactions. Since rash and oral blisters may be the first signs of TEN in patients receiving these it is mandatory to follow up these patients closely to detect oral or cutaneous changes indicating the development of TEN.
Abteilung für Oralchirurgie und zahnärztliche Röntgenologie, Universitätsklinikum Charité, Humboldt Universität zu Berlin, Germany.
A
A
Schmidt-Westhausen
T
T
Grünewald
P A
PA
Reichart
H D
HD
Pohle
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000890:Anti-Infective Agents / Q000009:adverse effects*; D004338:Drug Combinations; D005260:Female; D005436:Floxacillin / Q000009:adverse effects; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000139:chemically induced* / Q000209:etiology / Q000628:therapy; D009061:Mouth Mucosa / Q000187:drug effects*; D010406:Penicillins / Q000009:adverse effects; D011739:Pyrimethamine / Q000009:adverse effects*; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000209:etiology* / Q000628:therapy; D013413:Sulfadoxine / Q000009:adverse effects*
D000890:Anti-Infective Agents; D004338:Drug Combinations; D010406:Penicillins; C001205:fanasil, pyrimethamine drug combination; D005436:Floxacillin; D013413:Sulfadoxine; D011739:Pyrimethamine