Advanced HIV does not impact the ability to utilize lymphadenopathy in the assessment of DRESS syndrome in HIV and tuberculosis. A prospective comparative study.

Background RegiSCAR validation criteria for DRESS includes lymphadenopathy, a frequent feature of both tuberculosis (TB) and HIV. TB is the most common HIV-associated co-infection. Advanced HIV is associated with lymph node (LN) fibrosis. It is not clear if this negatively impacts case validation in HIV-associated DRESS. To answer this question, we designed a prospective descriptive study to assess lymphadenopathy in various co-morbid HIV/TB/DRESS combinations. Objectives To describe the prevalence of DRESS-associated lymphadenopathy and characterize LN quality, size, and distribution in a high HIV/TB burden setting over time. Methods We prospectively and systematically examined LN in 25 consecutive acute DRESS cases hospitalized at a South African tertiary centre and 10 hospitalised non-DRESS HIV/TB co-infected controls. Results 14/25 cases(56%) were HIV-infected, with a median (IQR) CD4 count of 254(66-478) cells/mm3 and 7/14 were TB co-infected. Using RegiSCAR criteria, 12/25(46%) were definite, 8/25(31%) probable and 5/25(23%) possible DRESS cases. Possible cases were excluded in the analysis. 15/20(75%) had LN in ≥2 anatomical sites, including 7/7(100%) with HIV/TB co-infection. In contrast, 1/5(20%) hospitalised non-DRESS HIV/TB co-infected controls had LN. Cervical LN in 15/17(88%) was commonest, followed by axillary (76%) and inguinal (59%) respectively. Cervical LN ranged between 1- 2cm in size. Amongst the 8/25(32%) that followed up, LN had regressed in all within 6 weeks of stopping the offending drug and initiation of TB treatment. There was no correlation with CD4 cell count and LN. Conclusion Lymphadenopathy is a common feature of acute DRESS even amongst HIV and TB-co-infected patients with advanced immunosuppression.