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CLINICAL IMAGE
Year : 2013  |  Volume : 138  |  Issue : 3  |  Page : 368-369

Stevens Johnson syndrome in a patient with HIV & visceral leishmaniasis


1 Division of Clinical Medicine, Rajendra Memorial, Research Institute of Medical Sciences, (Indian Council of Medical Research) Agamkuan, Patna 800 007, India
2 Division of Molecular Biology, Rajendra Memorial, Research Institute of Medical Sciences, (Indian Council of Medical Research) Agamkuan, Patna 800 007, India

Date of Web Publication8-Oct-2013

Correspondence Address:
Krishna Pandey
Division of Clinical Medicine, Rajendra Memorial, Research Institute of Medical Sciences, (Indian Council of Medical Research) Agamkuan, Patna 800 007
India
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Source of Support: None, Conflict of Interest: None


PMID: 24135185

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How to cite this article:
Pandey K, Singh D. Stevens Johnson syndrome in a patient with HIV & visceral leishmaniasis. Indian J Med Res 2013;138:368-9

How to cite this URL:
Pandey K, Singh D. Stevens Johnson syndrome in a patient with HIV & visceral leishmaniasis. Indian J Med Res [serial online] 2013 [cited 2020 Feb 23];138:368-9. Available from: http://www.ijmr.org.in/text.asp?2013/138/3/368/119381

A 35 year old female patient from Bihar, India, attended out-patient-clinic of Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna in October, 2012 with fever, weakness and frequent loose motions of four weeks duration. She had hepatosplenomegaly and anaemia. Body mass index (BMI) was 15 kg/m [2] , peripheral blood eosinophil count was 4 per cent (absolute count 276/μl). Immunochromatographic strip (rK-39) test was positive by serum, urine, and sputum samples and confirmation of visceral leishmaniasis (VL) was done by blood PCR and splenic aspirate [1],[2],[3] . She was treated for VL with amphotericin-B, 1 mg/kg body weight for 15 injections intravenously in 5 per cent dextrose on alternate days. After treatment her splenic aspirate and blood PCR were negative. She was HIV-1 positive with CD 4 count 228/μl and WHO clinical stage IV. Treatment was started with zidovudine (300 mg), lamivudine (150 mg) both twice daily, and nevirapine (200 mg) once daily. After seven days she developed multiple papular rashes with erythematous eruption all over the body, face and mucous membranes [Figure 1], [Figure 2]. She was diagnosed with Stevens Johnson syndrome due to nevirapine therapy [4] . The hepatic function tests were normal. Antiretroviral treatment (ART) was stopped, and the patient was put on anti-histaminics. ART regimen was changed to protease inhibitor based. The patient recovered and papular erythematous rashes disappeared.
Figure 1. Papular erythematous patches on chest, arms, abdomen and face.

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Figure 2. Papular erythematous patches seen on patient's back.

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   References Top

1.Salotra P, Sreenivas G, Pogue GP, Lee N, Nakhasi NL, Ramesh V, et al. Development of a species-specific PCR assay for detection of Leishmania donovani in clinical samples from patients with kala-azar and post-kala-azar dermal leishmaniasis. J Clin Microbiol 2001; 39 : 849-54.  Back to cited text no. 1
    
2.Singh D, Pandey K, Das VN, Das S, Kumar S, Topno RK, et al. Novel noninvasive method for diagnosis of visceral leishmaniasis by rK39 testing of sputum samples. J Clin Microbiol 2009; 47 : 2684-5.  Back to cited text no. 2
    
3.Singh D, Pandey K, Das VN, Das S, Verma N, Ranjan A, et al. Evaluation of rK-39 Strip test using urine for diagnosis of visceral leishmaniasis in an endemic region of India. Am J Trop Med Hyg 2013; 88 : 222-6.  Back to cited text no. 3
    
4.Singh H, Kachhap VK, Kumar BN, Nayak K. Nevirapine induced Stevens-Johnson syndrome in an HIV infected patient. Indian J Pharmacol 2011; 43 : 84-6.  Back to cited text no. 4
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