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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Scientific Journal of Dermatology and Venereology
Aulia Yasmin
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi General Hospital, Surakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Excess Adiposity Predicts In-Hospital Mortality but Not SCORTEN in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Three-Year Retrospective Cohort at Dr. Moewardi General Hospital, Surakarta Nugrohoaji Dharmawan; Aulia Yasmin
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 10 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i10.1666

Abstract

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare drug-induced reactions in which in-hospital death occurs in 12–49% of cases, yet the reference prognostic instrument, SCORTEN, contains no anthropometric variable. Whether body mass index (BMI) carries independent prognostic information is unknown. Objective: To determine whether body mass index carries independent prognostic information — for in-hospital mortality and for the SCORTEN severity score — in adults admitted with Stevens–Johnson syndrome and toxic epidermal necrolysis. Methods: This retrospective observational analytic study used total sampling of the ICD-10 L51.1/L51.2 admission register at Dr. Moewardi General Hospital, Surakarta, from January 2022 to December 2024. Forty-three adults were classified by Asia-Pacific BMI thresholds and analysed against SCORTEN, diagnostic class and in-hospital mortality using exact, Firth-penalised and interval-valued methods, with STROBE reporting. Results: Eight patients died (18.6%; 95% CI 9.7–32.6). BMI was not associated with SCORTEN (Spearman ρ = 0.163; 95% CI −0.14 to 0.44; p = 0.296), and all 3,280 exhaustively enumerated reconstructions of the incompletely reported score distribution reproduced a non-significant coefficient (ρ 0.061–0.287); the minimum detectable |ρ| was 0.42, so this null is uninformative rather than negative (BF01 = 3.10). Mortality rose across the ordered BMI strata from 0% to 36.4% (Cochran–Armitage z = 2.053; p = 0.040, exact permutation p = 0.056), and at the Asia-Pacific overweight threshold reached 35.3% versus 7.7% (odds ratio 6.55; 95% CI 1.14–37.75; Fisher exact p = 0.042; Firth-penalised odds ratio 5.54, 95% CI 1.20–34.09; number needed to harm 3.6; E-value 8.65; fragility index 1). Conclusion: Excess adiposity is associated with in-hospital death in Indonesian patients with epidermal necrolysis through a channel SCORTEN does not capture. The estimate is imprecise and requires prospective multicentre confirmation.
Multiple Giant Molluscum Contagiosum Arising on Antiretroviral Therapy: A Visible Marker of Unrecognized Immunological Failure in Advanced HIV Disease Aulia Yasmin; Endra Yustin Ellistasari; Ammarilis Murastami; Prasetyadi Mawardi
Scientific Journal of Dermatology and Venereology Vol. 4 No. 1 (2026): Scientific Journal of Dermatology and Venereology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjdv.v4i1.325

Abstract

Background: Molluscum contagiosum is ordinarily self-limiting, but in profound immunosuppression it becomes extensive, giant and atypical. Published reports almost uniformly describe such lesions as revealing previously undiagnosed HIV; lesions arising in a patient already established on antiretroviral therapy are far less often described and carry a more urgent meaning. Objective: To describe a fatal case of giant molluscum contagiosum arising on antiretroviral therapy, to show that the eruption marked unrecognized immunological failure, and to specify the measurements the dermatological consultation should have triggered. Case Presentation: A 39-year-old man presented with one year of enlarging papules and nodules on the eyelids, face, neck, hand and penis, the largest 3.5 × 2.5 × 1.5 cm, and 18 months of pruritic hyperpigmented limb papules, after 24 months of fixed-dose efavirenz, lamivudine and tenofovir disoproxil. Dermoscopy, Giemsa cytology and histopathology confirmed molluscum contagiosum; the limb eruption was pruritic papular eruption. CD4 was 31 cells/µL and CD8 1624 cells/µL, a CD4/CD8 ratio of 0.02; syphilis serology was non-reactive. Serial excision and enucleation, with weekly 90% trichloroacetic acid to the penile lesions, cleared the facial disease by month 3; he died at month 7. No viral load, resistance genotype, cryptococcal antigen or tuberculosis screen was performed. Conclusion: Giant molluscum contagiosum arising after two years of antiretroviral therapy marks therapy that is not working, not merely advanced HIV disease. An audit identified five indicated measurements never obtained. Dermatologists recognizing this eruption should treat the skin and, at the same visit, trigger a viral load and the advanced HIV disease package of care.
Co-Authors Ammarilis Murastami Endra Yustin Ellistasari Nugrohoaji Dharmawan Prasetyadi Mawardi