IADR Abstract Archives
Challenge in Management of Stevens-Johnson Syndrome and Oral Pseudomembranous Candidiasis in HIV Patient
Objectives: This case report will discuss a case of SJS in HIV patient, whose management is complicated with the presence of pseudomembrane candidiasis.
Methods: A 40-year-old HIV positive male inpatient who were already diagnosed with nevirapine-induced SJS by the dermatoveneorologist was consulted to oral medicine division of Cipto Mangunkusumo General Hospital because of crusted lips and erosions inside the oral cavity. He was already on intravenous corticosteroid. On examination, we found hemorrhagic crusts of the lips, multiple erosions and erythema of the oral mucosa, which was consistent with oral manifestation of SJS, and pseudomembrane candidiasis under the upper removable denture. The patient was in advanced immunosuppression (CD4 level 5 cells/μL) with cytomegalovirus (CMV) and hepatitis C virus (HCV) coinfection, marked by the presence of anti CMV and anti HCV antibody. The presence of pseudomembrane candidiasis complicated the management of oral manifestation of SJS in this patient. Oral manifestation of SJS has to be treated with corticosteroid mouthwash, while corticosteroid itself can be a risk factor for oral candidiasis. The patient was using upper and lower denture, was HIV positive, and being treated with high dose systemic corticosteroid, which were also risk factors for oral candidiasis. Therefore, we not only treated the patient for the oral manifestation of SJS, but also gave antifungal to treat the oral candidiasis. In an immunocompromised patient with two different conditions whose treatment is contradictory, management can be a challenge. Considerations should be made and the holistic treatment of the patient should not be overlooked.
Results: Clinical Case, not applicable
Conclusions: Clinical Case, not applicable
Methods: A 40-year-old HIV positive male inpatient who were already diagnosed with nevirapine-induced SJS by the dermatoveneorologist was consulted to oral medicine division of Cipto Mangunkusumo General Hospital because of crusted lips and erosions inside the oral cavity. He was already on intravenous corticosteroid. On examination, we found hemorrhagic crusts of the lips, multiple erosions and erythema of the oral mucosa, which was consistent with oral manifestation of SJS, and pseudomembrane candidiasis under the upper removable denture. The patient was in advanced immunosuppression (CD4 level 5 cells/μL) with cytomegalovirus (CMV) and hepatitis C virus (HCV) coinfection, marked by the presence of anti CMV and anti HCV antibody. The presence of pseudomembrane candidiasis complicated the management of oral manifestation of SJS in this patient. Oral manifestation of SJS has to be treated with corticosteroid mouthwash, while corticosteroid itself can be a risk factor for oral candidiasis. The patient was using upper and lower denture, was HIV positive, and being treated with high dose systemic corticosteroid, which were also risk factors for oral candidiasis. Therefore, we not only treated the patient for the oral manifestation of SJS, but also gave antifungal to treat the oral candidiasis. In an immunocompromised patient with two different conditions whose treatment is contradictory, management can be a challenge. Considerations should be made and the holistic treatment of the patient should not be overlooked.
Results: Clinical Case, not applicable
Conclusions: Clinical Case, not applicable