Challenges in managing Steven Johnson Syndrome with chronic ocular and extraocular abnormality.
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Abstract
Background: Stevens-Johnson syndrome (SJS) is one of the most debilitating adverse drug reactions which can lead to ocular complications, making management more challenging with multiple options for surgical approaches.
Case report: A 10-year-old girl with a history of SJS presented with difficulty opening both eyes after a symblepharon release surgery twice in other hospital. Unfortunately, there was still recurrence of symblepharon in both eyes followed with trichiasis and entropion. The multistep surgical approaches for ocular restoration were symblepharon lysis surgery, followed by amnion membrane transplant and conformer shell placement on both eyes. The shells were released one month after the initial surgery. After being treated for several months, the patient underwent eyelid reconstruction surgery for trichiasis and entropion to provide better ocular surface. Nevertheless, these approaches still showed recurrence of symblepharon in the left eye 6 months after the initial surgery.
Conclusion: Surgical approach should be patient-tailored based on complexity and severity of the ocular complications of SJS. Comprehensive management in treating SJS is required since the presence of systemic processes and complications are always possible.
Conflict of interest: none.
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References
2. Tyagi S, Kumar S, Kumar A. Stevens-Johnson Syndrome - a life threatening skin disorder: a review. J Chem Pharm Res. 2010;2(2):618-26.
3. Yip LW, Thong BY, Lim J, et al. Ocular manifestations and complications of Stevens-Johnson syndrome and toxic epidermal necrolysis: an Asian series. Allergy. 2007;62:527-31.
4. Wetter DA, Camilleri MJ. Clinical, etiologic and histopahtologic features of Stevens-Johnson syndrome during an 8-year period at Mayo Clinic. Mayo Clin Proc. 2010;85(2):131-8.
5. Kheirkhah A, Blanco G, Casas V, et al. Surgical strategies for fornix reconstruction based on symblepharon severity. Am J Ophthalmol. 2008;146(2):266-75.
6. Shay E, Kheirkhah A, Liang L, et al. Amniotic membrane transplantation as a new therapy for the acute ocular manifestations of Stevens-Johnson syndrome and toxic epidermal necrolysis. Surv Ophthalmol. 2009;54(6):686-96.
7. Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39.
8. Lee HY, Martanto W, Thirumoorthy T. Epidemiology of Stevens-Johnson syndrome and toxic epidermal necrolysis in Southeast Asia. Dermatologica Sinica. 2013;31:217-20.
9. French LE, Prins C. Erythema Multiforme, Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. In: Bolognia JL, Jorrizzo JL, Schaffer JV, editors. Dermatology. 3rd ed. Philadelphia Elsevier; 2012. p. 319-33.
10. Gregory DG. The ophthalmologic management of acute Stevens-Johnson syndrome. Ocul Surf. 2008;6(2):87-95.
11. Kano Y, Shiohara T. Long-term outcome of patients with severe cutaneous adverse reactions. Dermatologica Sinica. 2013;31(4):211-6.
12. Sotozono C, Ang LP, Koizumi N, et al. New grading system for evaluation of chronic ocular manifestation in patients with Stevens-Johnson syndrome. Ophthalmology. 2007;114(7):1294-302.
13. Manuelpillai U, Moodley Y, Borlongan CV, et al. Amniotic membrane and amniotic cells: potential therapeutic tools to combat tissue inflammation and fibrosis. Placenta. 2011;32:S320-S5.
14. John T, Foulks GN, John ME, et al. Amniotic membrane in the surgical management of acute toxic epidermal necrolysis. Ophthalmology. 2002;109(2):351-60.
15. Kawasaki S, Nishida K, Sotozono C, et al. Conjunctival inflammation in the chronic phase of Stevens-Johnson syndrome. Br J Ophthalmol. 2000;84(10):1191-3.
16. Mai C, Bertelmann E. Oral mucosal grafts: old technique in new light. Ophthalmic Res. 2013;50(2):91-8.
17. Saeed H, Mantagos IS, Chodosh J. Complications of Stevens-Johnson syndrome beyond the eye and skin. Burns. 2016;42(1):20-7.