A diagnosis of Stevens-Johnson Syndrome (SJS) in a patient presenting with superficial keratitis

Abstract

PurposeTo describe a case of Stevens-Johnson syndrome (SJS) diagnosed in a patient presenting with primarily ocular findings where SJS had not been initially suspected.ObservationsA 23-year-old female presented with a 2 day history of bilateral eye pain, conjunctival injection, decreased visual acuity, and photophobia in the context of a 4 day history of fever, headache, and sore throat. She was found to have bilateral superficial keratitis and treated for suspected early infectious keratitis secondary to extended contact lens wear. She returned the next day with worsening visual symptoms, a new macular rash over her upper torso, and new ulcerating lesions over her buccal and perioral tissue. The patient was diagnosed with SJS. She was successfully treated using systemic cyclosporine with antibiotics and steroid eye drops.Conclusions and importanceOphthalmologists may be the first physicians to diagnose SJS, a life-threatening condition that can initially present with non-specific viral prodromal symptoms and ocular signs alone. This case emphasizes the importance of considering a patient's entire clinical history, especially when the presentation is atypical and the diagnosis is not obviously apparent.

Case report: Concomitant use of nightly vitamin A ointment with daily PROSE wear for ocular surface disease associated with chronic Stevens-Johnson syndrome

“… 14 Systemic cyclosporine may be effective in slowing disease progression, however, it still remains relatively less studied in comparison with corticosteroids, and immunosuppression remains a concerning risk. 15 , 16 The use of topical bevacizumab applied in the fluid reservoir of a PROSE device has also shown promise to reduce corneal neovascularization in chronic ocular SJS. In a retrospective case series of 12 patients treated for corneal neovascularization, of whom 7 had SJS, addition of topical bevacizumab led to regression of corneal neovascularization in 92% of cases and improved visual acuity in 77% of cases.…”

Amniotic membrane transplantation in a 2-month-old infant with toxic epidermal necrolysis

“…Atypical cases of SJS/TEN may initially present with ocular signs only. 5 Prompt diagnosis of ocular surface inflammation and early intervention are essential to avoid cicatricial keratoconjunctivitis and limbal stem cell deficiency that may lead to vision threatening complications. AMT performed in the first week after ocular involvement has been reported to be an effective treatment modality due to anti-inflammatory and anti-scarring effects mediated by anti-inflammatory cytokines, including interleukin-10 and anti-inflammatory protease inhibitors such as alpha 1 antitrypsin inhibitor.…”

Tata Laksana Terintegrasi Sindrom Stevens-Johnson (SJS) dan Nekrolisis Epidermal Toksik (NET)

“…Beberapa jenis antibiotik seperti cefalosporin, quinolone, tetracycline, dan aminopenicillin memiliki risiko lebih rendah. 2 Terdapat beberapa laporan SSJ terkait clindamycin, 11,12 obat herbal, dan obat yang dikonsumsi bersamaan. [13][14][15] Selain obat-obatan, SSJ-NET dapat terjadi secara idiopatik atau tidak terkait obat-obatan.…”