Dolutegravir induced Stevens-Johnson syndrome in a newly diagnosed person living with HIV

Hypersensitivity reactions are notably more frequent among people living with HIV, ranging from benign cutaneous eruptions to severe conditions like Stevens–Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). These reactions arise from multifactorial mechanisms; altered drug metabolism, immune dysregulation, viral co-infections, and genetic susceptibility. Frequently implicated agents include abacavir, nevirapine, and medications for opportunistic infections. Though uncommon, integrase inhibitor associated hypersensitivity has been reported. This case describes the first documented occurrence of SJS in Sri Lanka related to the fixed-dose regimen of Dolutegravir, Lamivudine, and Tenofovir Disoproxil Fumarate (TLD).
A 42-year-old male developed SJS after initiating TLD and cotrimoxazole. Following recovery, re-exposure to TLD without cotrimoxazole reproduced hypersensitivity symptoms, suggesting dolutegravir as the causative agent. A Darunavir-based second line regimen was subsequently successfully introduced.
This report reinforces the need for early recognition, diagnostic caution, and enhanced pharmacovigilance even for newer antiretroviral therapies with favourable safety profile.