Isaacs Thuraya, Ngwanya Mzudumile R, Dlamini Sipho, Lehloenya Rannakoe J
Division of Dermatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
J Antimicrob Chemother. 2013 Dec;68(12):2871-4. doi: 10.1093/jac/dkt287. Epub 2013 Jul 12.
In HIV-infected persons, a rash is the most common manifestation of drug hypersensitivity reactions. Non-nucleotide reverse transcriptase inhibitors are a major cause of cutaneous reactions. While the characteristics of nevirapine-associated cutaneous adverse drug reactions (CADRs) have been well described, there are limited data on efavirenz-associated CADRs. The objective of this study was to characterize the clinical features of consecutive cases of efavirenz-associated CADRs in a single referral centre diagnosed over a 3 year period.
We retrospectively reviewed the clinical records of 231 patients admitted with CADRs to a tertiary dermatology ward in Cape Town, South Africa.
In 42/231(18%) cases, there had been exposure to efavirenz in the preceding 8 weeks. Of these, 5/42 (12%) patients were diagnosed with probable efavirenz-associated CADRs based on the Naranjo score. The median exposure to efavirenz before the onset of the rash was 12 days (range 2-48). All the patients were female, with a median age of 31 years and a median CD4 cell count of 300 cells/mm(3) (range 81-887). Four had a photo-distributed eruption and one had a confluent indurated erythema affecting the face, trunk and limbs. In three out of five cases, there were annular plaques with raised erythematous edges and dusky centres, which were photo-distributed. Two patients had a mild transaminitis and another a mild eosinophilia. Histological features were non-specific, with perivascular lymphocytes the only consistent feature. In all five cases, efavirenz was withdrawn and potent topical steroid was the only CADR-specific intervention. The eruptions resolved on discharge from hospital, with no sequelae except for residual post-inflammatory hyperpigmentation.
Photo-distribution and annular erythema should alert clinicians to the possibility of efavirenz-associated CADRs.
在HIV感染者中，皮疹是药物过敏反应最常见的表现。非核苷类逆转录酶抑制剂是皮肤反应的主要原因。虽然奈韦拉平相关的皮肤药物不良反应（CADR）的特征已得到充分描述，但关于依非韦伦相关CADR的数据有限。本研究的目的是在一个单一的转诊中心，对3年内诊断的依非韦伦相关CADR连续病例的临床特征进行描述。
我们回顾性分析了南非开普敦一家三级皮肤科病房收治的231例CADR患者的临床记录。
在231例病例中的42例（18%）中，患者在之前8周内接触过依非韦伦。其中，根据纳兰霍评分，5/42（12%）例患者被诊断为可能的依非韦伦相关CADR。皮疹出现前依非韦伦的中位暴露时间为12天（范围2 - 48天）。所有患者均为女性，中位年龄31岁，CD4细胞计数中位数为300个细胞/mm³（范围81 - 887）。4例出现光分布性皮疹，1例出现累及面部、躯干和四肢的融合性硬结红斑。5例中有3例出现边缘红斑隆起、中心发暗的环状斑块，呈光分布。2例患者有轻度转氨酶升高，另1例有轻度嗜酸性粒细胞增多。组织学特征无特异性，血管周围淋巴细胞是唯一一致的特征。所有5例患者均停用依非韦伦，强效外用类固醇是唯一的CADR特异性干预措施。皮疹在出院时消退，除残留炎症后色素沉着外无后遗症。
光分布和环状红斑应提醒临床医生注意依非韦伦相关CADR的可能性。
