title: Toxic epidermal necrolysis and Stevens-Johnson syndrome in South Africa: a 3-year prospective study.
abstract: BACKGROUND
  Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) remain feared medication-related reactions. HIV infection and tuberculosis predispose to drug eruptions, yet there is a paucity of data on TEN/SJS in populations with high prevalences of both diseases.
  
  
  OBJECTIVE
  The aim of this prospective observational study was to describe the features and outcomes of patients admitted with TEN/SJS at a large academic hospital in South Africa. We aimed to identify poor prognostic indicators and to validate the use of the TEN-specific severity-of-illness score (SCORTEN) in this population.
  
  
  METHODS
  All patients admitted with TEN/SJS over a 3-year period were enrolled. Disease severity was graded according to percentage skin involved and SCORTEN. Co-morbid diagnoses, clinical features, investigations, complications and outcomes were noted.
  
  
  RESULTS
  75 patients (39.9 ± 10.6 years, 16 males, 59 HIV positive) were classified as TEN (n  = 42), TEN/SJS overlap (n = 11) and SJS (n = 22). Twenty-four percent died, most from refractory septic shock. Non-survivors had a higher mean SCORTEN on Days 1 and 3 (1.89 vs. 1.04, P = 0.006 and 2.27 vs. 0.90, P < 0.001). A SCORTEN ≥2 on Days 1 and 3 predicted non-survival (OR = 2.94, P = 0.047; OR = 7.45, P < 0.001). Other predictors of non-survival included HIV infection (OR = 6.01, P = 0.058), HIV-tuberculosis co-infection (OR = 8.5, P < 0.001), ≥40% skin involvement (OR = 20.27, P < 0.001), anaemia (OR = 4.68, P = 0.005), hypoalbuminemia (OR = 8.5, P = 0.001) and severe sepsis (OR = 71.09, P < 0.001).
  
  
  CONCLUSIONS
  Most patients with TEN/SJS were HIV positive and female. We validated the use of SCORTEN and identified several prognostic indicators, most significant being HIV-tuberculosis co-infection, ≥40% skin involvement and severe sepsis.
authors.affiliation: Department of Medicine, University of Stellenbosch, Tygerberg, Cape Town, South Africa. surethakannenberg@hotmail.com
authors.forename: S M H
authors.initials: SM
authors.lastname: Kannenberg
authors.forename: H F
authors.initials: HF
authors.lastname: Jordaan
authors.forename: C F N
authors.initials: CF
authors.lastname: Koegelenberg
authors.forename: F
authors.initials: F
authors.lastname: Von Groote-Bidlingmaier
authors.forename: W I
authors.initials: WI
authors.lastname: Visser
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000401:mortality; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced / Q000209:etiology / Q000401:mortality*