Ocular and Mucocutaneous Sequelae among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Togo

Abstract

Aim. The aim of this study was to assess ocular and mucocutaneous sequelae among SJS/TEN survivors and identify risk factors of ocular sequelae. Patients and Method. Late complications among SJS/TEN survivors were assessed using 2 methods: a retrospective assessment of medical records only or a retrospective assessment of medical records and physical examination of survivors who were contacted by phone. Results. Between January 1995 and December 2017, 177 cases of SJS/TEN (138 cases of SJS, 29 cases of TEN, and 10 cases SJS/TEN overlap) were admitted into two university hospitals of Lomé (Togo). There were 113 women and 64 men, with an average age of 31.7±13.0 years (range: 5 to 80 years). The most used drugs were antibacterial sulfonamides (35.6%) and nevirapine (24.3%). HIV serology was positive in 68 (59.1%) of the 115 patients tested. Sixty-four (52,5%) of the 122 patients, who had been examined by an ophthalmologist during the acute stage, had acute ocular involvement, which was mild in 27.9% of patients, moderate in 13.1%, and severe in 11.5%. We recorded 17 deaths (i.e., three cases of SJS, 12 of TEN, and two of SJS/TEN overlap), including 11 cases of HIV infected patients. Of the 160 SJS/TEN survivors, only 71 patients were assessed 6 months after hospital discharge. Among them, forty-three (60.6%) patients had sequelae. Concerning mucocutaneous sequelae, the main lesions were diffuse dyschromic macules (38.0% of patients) and ocular sequelae were dominated by decreased visual acuity (14.1% of patients). In multivariate analysis, exposure to sulfadoxine (odds adjusted ratio = 5.95; 95%CI= [1.36-31.35]) and moderate (adjusted odds ratio = 5.85; 95%CI = [1.23-31.81]) or severe (adjusted odds ratio = 48.30; 95%CI = [6.25-1063.66]) ocular involvement at acute stage were associated with ocular sequelae. Conclusion. Ocular and mucocutaneous sequelae are common in SJS/TEN survivors. Exposure to sulfadoxine and severity of acute ocular involvement are risk factors of ocular sequelae.

Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study

“…Sequelaeoccurred in 13 patients (18.6%), mainly cutaneous skin issues (12.8%), followed by eye problems (4.2%). This is similar to the rates reported in other studies [62,63]. We found no psychiatric or autoimmune conditions, although a follow-up assessment of some patients may be needed in order to evaluate the long term effects and implications.…”

Quality of Life of Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) and Stevens-Johnson Syndrome (SJS) and/or Toxic Epidermal Necrolysis (TEN) Patients

“… 24 Another previous study stated that sulfadoxine exposure is one of the risk factors of ocular and mucocutaneous sequelae in SJS/TEN survivors. 25 …”

Pancytopenia in a Patient with Stevens-Johnson Syndrome: A Case Report with Literature Review

“…Stevens-Johnson syndrome (SJS) and TEN are a part of the spectrum of serious dermatological manifestations of drugs and can become life-threatening conditions in most instances [7]. These two conditions are differentiated based on the percentage of the body surface area affected, with SJS affecting less than 10% [2].…”

“…All mucous membranes have a tendency of being involved, with buccal, ocular, and genital mucosas more commonly while respiratory and gastrointestinal mucosas in rare instances. The most common early complications include superficial skin infections, sepsis, and pneumonia while long-term sequelae are categorized into skin (pruritis, hypertrophic scars), ocular (dry watery eyes, decreased visual acuity) and organ-specific (vaginal/labial adhesions, bronchiolitis obliterans) (Table 1) [2, 7, 10].…”