Acquired Immunodeficiency Syndrome Patient on Amphetamines with Toxic Epidermal Necrolysis

Case Report

Austin J Dermatolog. 2016; 3(1): 1043.

Acquired Immunodeficiency Syndrome Patient on Amphetamines with Toxic Epidermal Necrolysis

Yuan-Yu Hou*, Chi-Hsuan Chiang and Feng-Jie Lai

Department of Dermatology, Chi Mei Medical Center, Taiwan

*Corresponding author: Yuan-Yu Hou, Department of Dermatology, Chi Mei Medical Center, Taiwan

Received: December 08, 2015; Accepted: January 15, 2016; Published: January 18, 2016


Toxic Epidermal Necrolysis (TEN) is a life threatening disease. Marked keratinocyte apoptosis attributes extensive epidermis detachment. It is mostly drug-related. Aside from the common culprits such as allopurinol, anticonvulsants, antibiotics and Non-Steroid Anti-Inflammatory Drugs (NSAIDs), some reports pointed out that Human Immunodeficiency Virus (HIV) positive patients and amphetamine abusers suffer greater incidence of TEN. We report such a case. Although the pathophysiology of TEN is still veiled, it is believed that complex immune responses play an important role. Further studies for understanding this lethal disease need to be proceeded. Sepsis and multiple organ failure are the major causes of death. Prompt diagnosis and intensive care are imperative.

Keywords:Amphetamine; HIV; AIDS; TEN

Here we report a Human Immunodeficiency Virus (HIV) positive patient on amphetamines with toxic epidermal necrolysis.

Case Presentation

A 24 year-old man who was diagnosed with HIV infection and never received therapy for AIDS. Fever, malaise, sore throat and conjunctivitis proceeded 3 days before skin lesions developed. Patient visited our emergency room, was admitted to burn center thereafter. Generalized painful erythematous to brownish patches with multiple eroded bullae and macules over trunk and extremities were noticed. The skin lesions started from upper trunk and face, and then spread to other parts of the body and extremities, with more than 80% of total Body Surface Area (BSA) involved. Lesions were mostly in erythematous at the beginning, turned darker later on, and started peeling off as it progressed. Blisters/bullae were either flaccid or ruptured. The lesion extended by giving pressure, thus Nikolsky’s sign was positive on physical examination. In addition, oral ulcers, scrotal ulcers were also prominent (Figure 1). Patient denied any medication intake prior to the skin rashes, except amphetamine inhalation about 1 to 2 weeks previous to the above dermatologic examination. Similar but milder episode happened 2 months ago. During the admission period, significant laboratory data : WBC: 2500 /dl (3400-9100 /dL), Hematocrit (Hct): 36.6 % (40-49%), albumin: 3.1 g/dL (3.8-5.3 g/dL), CRP: 15.68 mg/L (< 3 mg/L), hemoglobin : 12.0 g/dL (13.5-17.5 g/ dL), S-GOT(AST)/S-GPT(ALT): 73/65 IU/L (10-50 IU/L), CD4+ lymphocyte counts: 207 /uL (404-1612 /uL), atypical lymphocytes: 2% (=0), CD4+/CD8 ratio: 0.6 (1.2-2.0), HIV viral load test: 125901 copies/ml (non-detected). The vital sign was stable. After admission, no sign of pulmonary embolism/edema, Acute Respiratory Distress Syndrome (ARDS), gastrointestinal hemorrhage, prerenal azotemia, acute tubular necrosis, hypovolemic shock or sepsis appeared.