Bilateral Microbial Keratitis in Highly Active Antiretroviral Therapy-induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Case Series

Sachdev, Ritika; Bansal, Shubha; Sinha, Rajesh; Sharma, Namrata; Titiyal, Jeewan S

doi:10.3109/09273948.2011.601389

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…Although rarely reported, 10,11,[14][15][16] MK in patients with SJS/TEN shares common features: more bilateral involvement and polymicrobial infection, the most common pathogen being Staphylococcus spp., a higher rate requiring surgical intervention, and poorer visual outcome. Our findings indicate that in addition to severe ocular surface disorders, topical steroid and therapeutic SCL wearing are both important risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…Sixteen eyes from 12 patients with SJS (n = 5), overlap syndrome (n = 3), and TEN (n = 4) developed MK. All eyes were categorized as having severe ocular involvement according to Sotozono grading in an acute setting and had an average chronic severity score of 15.5 6 5.7 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Table 1 presents the patient demographics and characteristics.…”

Section: Clinical Characteristics Of the Patientsmentioning

confidence: 99%

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Microbial Keratitis in Patients With Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Experience From a Tertiary Centre in Taiwan

Tsai

Adiyabazar

Hsiao

et al. 2022

Cornea

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Characteristics Of the Patientsmentioning

confidence: 99%

Microbial Keratitis in Patients With Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Experience From a Tertiary Centre in Taiwan

Tsai

Adiyabazar

Hsiao

et al. 2022

Cornea

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“…1 These three processes occur continuously so that several clinical manifestations arise including pseudomembrane formation, symblepharon, necrosis of the eyelid margin, recurrent meibomitis, shortened fornix, corneal degeneration, cornea ulcer progressing to perforation, and ultimately permanent blindness. [16][17][18] The primary pathogenesis of SJS has not been fully elucidated to date, but previous studies and literature point to immunological and genetic factors. 1,8 The acute phase of SJS is the result of a type IV hypersensitivity reaction mediated by cytotoxic T cells.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Severe Dry Eye in Stevens-Johnson Syndrome with Umbilical Cord Serum Eye Drops

Susiyanti¹,

Kurnia²,

Fasha³

et al. 2022

OPTH

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Purpose To evaluate the efficacy and safety of umbilical cord serum eye drops for dry eyes in ocular Stevens-Johnson Syndrome (SJS). Patients and Methods A pre-post test study with umbilical cord serum (UCS) eye drop for ocular SJS patient with moderate to severe dry eyes. Study was conducted at Kirana Cipto Mangunkusumo General Hospital from June 2020 to December 2020. A total of five patients (five eyes) with a diagnosis of SJS more than 6 months, dry eye symptoms, and abnormal tear stability test results were included in the study. Each patient was asked to instill UCS drop into the affected eye six times daily. Evaluation of ocular symptoms with ocular surface disease index (OSDI) questionnaires, non-invasive tear break-up time (NIBUT), Schirmer I, and keratoepitheliopathy scores was administered before applying UCS drop and at week 2 and 4 of eye drop use. Results From June 2020 to December 2020, five eyes of five patients were evaluated in this study. Patients were aged from 22 to 71 years old with history of SJS over periods from 1 to 35 years. Three patients underwent ocular surgeries prior to the study. After four weeks of treatment, symptoms score, Schirmer I, and keratoepitheliopathy scores improved significantly, while NIBUT scores improved insignificantly. No side effects were noted during treatment. Conclusion Administration of UCS eye drop was effective in improving symptoms and signs of dry eye in chronic SJS patients.

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“…The most frequent are conjunctivitis, 27 keratitis 28,29 and severe dry eye. 30 In a study conducted by Saka et al 31 in Lomé, Togo, described 3 cases of blindness.…”

Section: Discussionmentioning

confidence: 99%

Keratoconjunctivitis associated with nevirapine toxicity in HIV pregnant woman

Yáñez

2012

Optometry Rep

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Highly active antiretroviral therapy (HAART) is the treatment of choice for human immunodeficiency virus -acquired immunodeficiency syndrome (HIV-AIDS) patients. Severe side effects of these drugs have been described that produce generalized autoimmune blistering diseases, such as Stevens-Johnson syndrome and toxic epidermal necrosis (TEN). These complications may seriously compromise the patient's life or cause disabling consequences such as blindness. We describe a case of 21-year old female HIV patient with a CD4 count of 126 cells/microliter. Ten days post elective caesarean delivery she restarted HAART with nevirapine and developed TEN after approximately two weeks. Nevirapine was discontinued, but despite this, ocular surface disorder persisted. She presented severe bilateral keratoconjunctivitis that was treated with free tear substitutes, moxifloxacyn, and prednisolone acethate eye drops. At 2-month follow up her visual acuity without correction was 20/160 in the right eye and 20/40 in the left. She had bilateral moderate cicatricial keratoconjunctivitis and a central corneal leukoma in the right eye.Early treatment is important and should consist of preservative-free lubricants, and amniotic membrane transplantation to decrease the frequency of severe sequelae such as keratitis and corneal leukomas that will reduce the quality of life for these patients.

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Bilateral Microbial Keratitis in Highly Active Antiretroviral Therapy-induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Case Series

Abstract: The immune reconstitution occurring as a response to the antiretroviral therapy may potentially increase immunologically mediated diseases like SJS and TEN, which in turn may predispose the eye to develop corneal ulcer.

Cited by 11 publications

References 14 publications

Microbial Keratitis in Patients With Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Experience From a Tertiary Centre in Taiwan

Microbial Keratitis in Patients With Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Experience From a Tertiary Centre in Taiwan

Treatment of Severe Dry Eye in Stevens-Johnson Syndrome with Umbilical Cord Serum Eye Drops

Keratoconjunctivitis associated with nevirapine toxicity in HIV pregnant woman

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