Analysis of Ocular Manifestation and Genetic Association of Allopurinol-Induced Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis in South Korea

Lee, Hyo Seok; Ueta, Mayumi; Kim, Mee Kum; Seo, Kyoung Yul; Sotozono, Chie; Kinoshita, Shigeru; Yoon, Kyung Chul

doi:10.1097/ico.0000000000000708

Cited by 17 publications

(13 citation statements)

References 34 publications

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“…Meanwhile, anticonvulsants, allopurinol, NSAIDs, and other drugs did not show any statistically significant relationship to long-term severe visual impairment. These findings are similar to prior studies from Japan and Korea which reported that cephalosporin-related SJS/TEN exhibited relatively higher tendencies of experiencing severe acute ocular surface involvements, although not significant (0.05 < P < 0.07), and patients with SJS/TEN that were associated with other drugs such as carbamazepine, allopurinol, and quinolones were not likely to develop severe ocular surface involvements [19, 20]. However, NSAIDs have previously been observed to be potentially associated with chronic complications in a specific genetic background [12, 13].…”

Section: Discussionsupporting

confidence: 89%

Factors Contributing to Long-Term Severe Visual Impairment in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Jongkhajornpong

Lekhanont

Siriyotha

et al. 2017

Journal of Ophthalmology

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Purpose. To study the correlation between demographics and clinical variables and long-term severe visual impairment in patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Methods. A retrospective chart review of SJS/TEN patients between 2004 and 2014 was conducted. Demographics, causative agents, ocular manifestations, and visual outcomes were collected. The data were analyzed using a multivariate logistic regression model. Results. Of the 89 patients including SJS (65, 73.03%), TEN (15, 16.85%), and SJS-TEN overlap (9, 10.11%), 55 were female. The mean age was 41.58 ± 19.17 years. The most common identified agents were medications. Among these groups, antibiotics were the most prevalent (47.19%). Three patients (3.7%) had unknown etiology. Antibiotics and nonpharmaceutical triggers were significantly associated with long-term severe visual impairment (odds ratio 4.32; P = 0.015 and 7.20; P = 0.037, resp.). There was a significant negative relationship between HIV infection and long-term severe visual impairment (P = 0.021). Among all chronic ocular complications, only corneal neovascularization significantly correlated with severe visual impairment (P = 0.001). Conclusions. SJS/TEN patients caused by nonpharmaceutical triggers or antibiotics have an increased risk of developing long-term severe visual impairment from corneal neovascularization. HIV infection might be a protective factor against long-term poor visual outcomes.

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Section: Discussionsupporting

confidence: 89%

Factors Contributing to Long-Term Severe Visual Impairment in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Jongkhajornpong

Lekhanont

Siriyotha

et al. 2017

Journal of Ophthalmology

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“…Thus, genetic predisposition such as HLA genotype might be different between SJS/TEN with and without SOCs 3. Moreover, HLA-A*02:06 and HLA-B*44:03 are not associated with cold medicine unrelated (other medicine related) SJS/TEN with SOCs,3 suggesting that genetic predisposition, such as HLA genotype, might be different depending on their causative drugs 353031…”

Section: Causative Drug and Human Leukocyte Antigen Analysismentioning

confidence: 99%

“…Interestingly, allopurinol might induce SJS/TEN without SOCs,30 and not all cases of carbamazepine-induced SJS/TEN have SOCs 2…”

Section: Causative Drug and Human Leukocyte Antigen Analysismentioning

confidence: 99%

Cold medicine-related Stevens–Johnson syndrome/toxic epidermal necrolysis with severe ocular complications—phenotypes and genetic predispositions

Ueta

2016

Taiwan Journal of Ophthalmology

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Stevens–Johnson syndrome (SJS) is an acute inflammatory vesiculobullous reaction of the skin and mucosa, such as the ocular surface, oral cavity, and genitals. In patients with extensive skin detachment and a poor prognosis, the condition is called toxic epidermal necrolysis (TEN). Severe ocular complications (SOCs) appear in some–but not all–SJS/TEN patients who are diagnosed by dermatologists, and cold medicines including multi-ingredient cold medications and nonsteroidal anti-inflammatory drugs are the main causative drugs particularly for SJS/TEN with SOCs and all SJS and TEN. In this review, we focus on the genetic predisposition of cold medicine-related SJS/TEN (CM-SJS/TEN) with SOCs. CM-SJS/TEN with SOCs was strongly associated with HLA-A*02:06 and significantly associated with HLA-B*44:03 in Japanese individuals, significantly associated with HLA-B*44:03 in Indian and Brazilian individuals, and associated with HLA-A*02:06 in Korean individuals. In the first genome-wide association study (GWAS), we found an association between the prostaglandin E receptor 3 (PTGER3) gene and SJS/TEN with SOCs. In this study, we focused on CM-SJS/TEN with SOCs and found that the association of CM-SJS/TEN with SOCs became stronger than all SJS/TEN with SOCs. In the second GWAS, we found an association between the IKZF1 gene and CM-SJS/TEN with SOCs not only in Japanese, but also in Korean and Indian populations. Moreover, we found that TSHZ2 gene single nucleotide polymorphisms (SNPs) also showed especially low p values in the Japanese population; however, this association was not found in the Korean population. Furthermore, we investigated the interaction between susceptibility genes, and found multiplicative interactions of HLA-A*02:06 and TLR3 SNPs and additive interactions of HLA-A*02:06 and PTGER3 SNPs.

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“…We reported an overall 53% acute ocular involvement rate in our series, and this fell into the reported range of 50 to 88% in the literature [6]. Most studies described SJS and TEN as a whole with no comparison between these groups [10, 12, 17–21], with a few exceptions [7, 14, 15]. Morales et al and Gueudry et al classified the cases into 3 categories (SJS, SJS/TEN overlap and TEN) and made comparisons [7, 14], while some studies focused on comparing SJS cases (<10% BSA involvement) with TEN (> = 30% BSA involvement) [15, 17].…”

Section: Discussionmentioning

confidence: 75%

Comparison of the acute ocular manifestations of Stevens-Johnson syndrome and toxic epidermal necrolysis in Chinese eyes: a 15-year retrospective study

et al. 2017

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BackgroundStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening conditions that initially affect the skin and mucous membranes. The aim of this study was to compare the acute ocular manifestations between SJS and TEN.MethodsThe initial presenting ophthalmic records of patients with either SJS (<30% body surface area involvement) or TEN (> = 30% involvement), who were treated at one tertiary burn center in Hong Kong between 1999 and 2014, were retrospectively analyzed and compared.ResultsA total of 20 SJS and 12 TEN cases were included. All were drug-induced. The patient demographics and treatment received were comparable. Overall, 40% of SJS and 75% of TEN patients had acute ocular surface inflammation. When comparing the two groups, there was a significant difference in the number of cases with mild involvement (5% in SJS, 42% in TEN, p = 0.01), while no statistically significant differences were found (p > 0.05) comparing between the moderate (15% in SJS, 0% in TEN) and severe groups (20% in SJS, 33% in TEN).ConclusionsOcular surface inflammation was common during the acute phase in both SJS and TEN. TEN had a significantly higher number of cases with mild ocular involvement when compared with SJS, but no significant difference between the number of moderate and severe cases between the two groups.

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Analysis of Ocular Manifestation and Genetic Association of Allopurinol-Induced Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis in South Korea

Abstract: Allopurinol-induced SJS/TEN might not cause serious acute or chronic complications of the ocular surface. In addition, our HLA genotyping results are consistent with previous studies reporting a strong association between HLA-B*58:01 and allopurinol-induced SJS/TEN among Koreans.

Cited by 17 publications

References 34 publications

Factors Contributing to Long-Term Severe Visual Impairment in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Factors Contributing to Long-Term Severe Visual Impairment in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Cold medicine-related Stevens–Johnson syndrome/toxic epidermal necrolysis with severe ocular complications—phenotypes and genetic predispositions

Comparison of the acute ocular manifestations of Stevens-Johnson syndrome and toxic epidermal necrolysis in Chinese eyes: a 15-year retrospective study

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