Severe skin rash with lamivudine in HIV infected patients: Some unusual case reports
In a 38-year-old male patient diagnosed to be HIV positive for last 6 years, ART was started with zidovudine, lamivudine, and nevirapine when his CD4 count dropped to 223/μL. He was admitted with pruritic, erythematous, maculopapular rash with blisters over genitalia, and multiple ulcers in buccal mucosa [] along with constitutional symptoms like fever and myalgia on the 7th day of starting ART. All medications including co-trimoxazole were stopped. On examination, he was febrile with maculopapular rash, patchy areas of desquamation, [] and multiple ulcers over oral and genital mucous membrane. SJS was diagnosed. His kidney and liver functions were normal. He was managed symptomatically in the hospital with disappearance of the rash by 7th day. Following complete resolution of rash, ART was re-started with lopinavir/ritonavir along with zidovudine and lamivudine. However, similar but more severe rash re-appeared after the first dose. All medicines were withdrawn. ART was subsequently restarted with tenofovir, zidovudine, and lopinavir/ritonavir after complete recovery of rash. He tolerated the drugs well and rash did not re-appear. Two months later lopinavir/ritonavir was substituted with efavirenz which was well-tolerated by the patient.