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Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis

Stevens–Johnson syndrome (SJS) and the more severe variant, toxic epidermal necrolysis (TEN), are a spectrum of mucocutaneous reactions with potentially devastating ocular consequences. Ocular complications occur in about 70% of patients with Stevens–Johnson syndrome, and 35% continue with chronic d...

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Autores principales: Bourke, Christine M., Cummings, Brendan K., Hurley, Daire J., Murphy, Conor C., Chamney, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456061/
https://www.ncbi.nlm.nih.gov/pubmed/37629300
http://dx.doi.org/10.3390/jcm12165259
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author Bourke, Christine M.
Cummings, Brendan K.
Hurley, Daire J.
Murphy, Conor C.
Chamney, Sarah
author_facet Bourke, Christine M.
Cummings, Brendan K.
Hurley, Daire J.
Murphy, Conor C.
Chamney, Sarah
author_sort Bourke, Christine M.
collection PubMed
description Stevens–Johnson syndrome (SJS) and the more severe variant, toxic epidermal necrolysis (TEN), are a spectrum of mucocutaneous reactions with potentially devastating ocular consequences. Ocular complications occur in about 70% of patients with Stevens–Johnson syndrome, and 35% continue with chronic disease. We report an unusual presentation of isolated ocular Stevens–Johnson syndrome in a patient with recently diagnosed ulcerative colitis being treated with Infliximab. The case had an insidious and atypical onset and represented a diagnostic dilemma. The diagnosis was more difficult, due to the fact that the inciting agent had long been stopped. Severe bacterial conjunctivitis such as that caused by Chlamydia Trachomatis, Corynebacterium diphtheria, and Neisseria Gonorrhea can cause forniceal shortening and symblepharon; this diagnosis was ruled out with microbiological swabs. A conjunctival biopsy was the key to diagnosis. Treatment involved high-dose IV steroids and dual immunosuppression with Infliximab and mycophenolate mofetil. We sought to employ interventions with the greatest impacts on our patient’s condition. Our experience contributes to the growing evidence supporting intensive ophthalmic management of SJS to prevent long-term vision loss.
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spelling pubmed-104560612023-08-26 Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis Bourke, Christine M. Cummings, Brendan K. Hurley, Daire J. Murphy, Conor C. Chamney, Sarah J Clin Med Case Report Stevens–Johnson syndrome (SJS) and the more severe variant, toxic epidermal necrolysis (TEN), are a spectrum of mucocutaneous reactions with potentially devastating ocular consequences. Ocular complications occur in about 70% of patients with Stevens–Johnson syndrome, and 35% continue with chronic disease. We report an unusual presentation of isolated ocular Stevens–Johnson syndrome in a patient with recently diagnosed ulcerative colitis being treated with Infliximab. The case had an insidious and atypical onset and represented a diagnostic dilemma. The diagnosis was more difficult, due to the fact that the inciting agent had long been stopped. Severe bacterial conjunctivitis such as that caused by Chlamydia Trachomatis, Corynebacterium diphtheria, and Neisseria Gonorrhea can cause forniceal shortening and symblepharon; this diagnosis was ruled out with microbiological swabs. A conjunctival biopsy was the key to diagnosis. Treatment involved high-dose IV steroids and dual immunosuppression with Infliximab and mycophenolate mofetil. We sought to employ interventions with the greatest impacts on our patient’s condition. Our experience contributes to the growing evidence supporting intensive ophthalmic management of SJS to prevent long-term vision loss. MDPI 2023-08-12 /pmc/articles/PMC10456061/ /pubmed/37629300 http://dx.doi.org/10.3390/jcm12165259 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Bourke, Christine M.
Cummings, Brendan K.
Hurley, Daire J.
Murphy, Conor C.
Chamney, Sarah
Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis
title Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis
title_full Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis
title_fullStr Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis
title_full_unstemmed Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis
title_short Isolated Ocular Stevens–Johnson Syndrome Caused by Lymecycline in a Patient with Underlying Ulcerative Colitis
title_sort isolated ocular stevens–johnson syndrome caused by lymecycline in a patient with underlying ulcerative colitis
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456061/
https://www.ncbi.nlm.nih.gov/pubmed/37629300
http://dx.doi.org/10.3390/jcm12165259
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