Iatrogenically induced Stevens-Johnson syndrome after a car accident.

BACKGROUND

Stevens-Johnson syndrome (SJS) is a hypersensitivity reaction that targets the skin and mucosal membranes. Ophthalmic manifestations may include conjunctival and corneal keratinization, shortening of the fornices, symblepharon, entropion, trichiasis, and adnexal cutaneous blisters. The syndrome is often misdiagnosed, and patients are treated incompletely with topical agents only leading to a worsening of the condition and graduated symptoms.

CASE

A 61-year-old black man was admitted to the hospital for management and rehabilitation of multiple lower limb fractures after an automobile accident. The ophthalmic service was consulted regarding a persistent bilateral conjunctivitis that was worsening and recalcitrant to standard topical antimicrobial therapies. Best-corrected visual acuities were 20/70 in the right eye (O.D.) and the left eye (O.S.) secondary to grade III punctate corneal epitheliopathy resulting from evolving cicatricial ectropion. Anterior segment examination uncovered maderosis, blepharoconjunctivitis and dense corneal subepithelial infiltration from 3 to 5 o'clock. Externally there was bilateral juxtaorbital and transfacial skin blistering. After a review of history, the diagnosis of SJS was made, presumably secondary to recent oral antibiotic administration. Topical and oral steroids were initiated while concurrently seeking a dermatologic consult. The dermatologist agreed with our findings and management. The disease responded to the oral and topical regimen with significant reduction of signs and symptoms. An immediate physical improvement was evident within 10 days.

CONCLUSIONS

Stevens-Johnson syndrome is a multifactorial hypersensitivity reaction requiring prompt systemic and local anti-inflammatory therapy.