Severe skin rash with lamivudine in HIV infected patients: Some unusual case reports
A 26-year-old HIV positive female patient was admitted with rapidly progressive pruritic, maculopapular, erythematous rash all over the body, without mucosal involvement that developed on 10th day after initiation of ART with zidovudine, lamivudine, and nevirapine. She was already on co-trimoxazole for 2 months. On physical examination, she was febrile and generalized rash was present all over the body without mucosal lesion. Her laboratory and biochemical parameters were normal; CD4 count was 34/μL. All medicines, including co-trimoxazole, were discontinued and the rash disappeared in 1 week. Similar type of rash with fever was observed after first dose of ART re-initiation with efavirenz, zidovudine, and lamivudine. Antiretroviral therapy was stopped. Six weeks after disappearance of cutaneous rash, ART was re-initiated with lopinavir/ritonavir, zidovudine, and lamivudine. Rash reappeared after the 1st dose of ART. Tenofovir was substituted for lamivudine following disappearance of rash. Subjective improvement started within 4 hours of lamivudine discontinuation with complete recovery being noted by two weeks. Rash was not associated with hepatosplenomegaly or lymphadenopathy in all the cases. Histopathology from the rash revealed mild acanthosis, focal spongiosis, and strong sub-epidermal edema.