STEVENS-JOHNSON SYNDROME in ACQUIRED IMUNODEFICIENCY SYNDROM (HIV/AIDS) Arnaldo Eka Putra* Raveinal* * Internal Medicine Resident

, Faculty of Medicine Andalas University Padang ** Subdivision of allergic and immunology Internal Medicine Department Faculty of Medicine Andalas University Padang Abstract Introduction Steven Johnson syndrome (SJS) is characterized by sudden onset of erosion of mucous membranes (predominantly oral mucosa, lips, and conjunctivae) with widespread blistering of the skin involving up to 10% of the body surface area. It is caused by several factors such as infections, drugs, and malignancies. Cotrimoxazole is a widely prescribed antimicrobial for the management of several uncomplicated infections. In immunocompetent persons, the adverse reactions to Cotrimoxazole occur in approximately 1-3% of persons. In contrast, in HIV-infected population, a much higher incidence of adverse reactions has been reported with frequencies ranging from 40-80%.. We report an HIV-infected man who developed SJS while receiving Cotrimoxazole, clindamycin, pyrimethamine therapy. Method : A Case Report Result : A 32-year-old male presented with complaints erosion of skin for 7 days before admitted to hospital, These symptom appear after treatment with cotrimoxazole, clindamysin, pyrimethamine. in further investigations the patient has burning sensation in his throat, high grade fever, loss of weight, and loss of appetite for six weeks. He also had sudden onset of weakness in left extremity, redness and pricking sensation in the eyes, blepharitis and cronic cough.. On examination, the patient was febrile with a pulse rate of 92/min, respiratory rate of 23/min and blood pressure of 100/70 mmHg. Mild pallor was present, Oral ulcer. Painful, erythematous, maculopapular, and vesicular lesions appeared all in the skin of face, extremity and stomach. There were multiple ulcerations in the buccal mucosa, floor of the mouth, and ventral surface of the tongue. Nikolsky's sign was positive. Respiratory system examination revealed bilateral ronchi. The investigation revealed HIV reactive, CD4 Level 25, and also anti-toxoplasma IgM,IgG (+). The chest X-ray we find Tuberculocis apparance, and in the non contras brain CT-scan appeare enhancement in right hemisfere with perifocal eodem. Conclusion Stevens Johnson syndrome (SJS) is characterized by sudden onset of erosion of mucous membranes. This case illustrates a clinically important and life threatening adverse effect of Cotrimoxazole , clindamicyn, pyrimethamine in HIV-infected patients. Due to the high incidence of such hypersensitivity reactions, physicians should monitor HIV-infected patients on Cotrimoxazole, clindamicyn, pyrimethamine therapy. Key Word : Stevens johnson syndrome, Human Immunodeficiency virus