Severe skin rash with lamivudine in HIV infected patients: Some unusual case reports
Severe maculopapular, pruritic rash, with conjunctival redness and mucosal involvement of the oral cavity and genitalia were observed on the 10th day of ARV initiation with zidovudine, lamivudine, and nevirapine in a 32-year-old female with CD4 count of 25 cells/μL. She was found to be allergic to co-trimoxazole earlier and the attempts at desensitization had failed. She was diagnosed with Steven-Johnson syndrome (SJS). Her laboratory parameters were normal. She improved following discontinuation of all the drugs and symptomatic management. ART was re-initiated with lopinavir/ritonavir, zidovudine, and lamivudine. However, she was admitted again with desquamation of skin of more than 30% of total body area, with exfoliative erythroderma, mucosal ulcers, conjunctival erosion, lacrimation and photophobia, and a diagnosis of toxic epidermal necrolysis (TEN) was made. All medicines were stopped and she recovered gradually in the next 4 weeks. Two months later, ART was re-started with tenofovir, zidovudine, and lopinavir/ritonavir, presuming lamivudine to be offending drug. She continued the drugs without any further adverse effects.