Saka Bayaki, Akakpo Abla Séfako, Teclessou Julienne Noude, Mahamadou Garba, Mouhari-Toure Abas, Dzidzinyo Kossi, Diori Adam Nouhou, Maneh Nidain, Prince-Agbodjan Sabin, Kombaté Koussake, Balo Komi, Tchangai-Walla Kissem, Pitché Palokinam
Dermatology Unit, Sylvanus Olympio Teaching Hospital, University of Lomé, Togo.
Dermatology Unit, Campus Teaching Hospital, University of Lomé, Togo.
Dermatol Res Pract. 2019 Jan 30;2019:4917024. doi: 10.1155/2019/4917024. eCollection 2019.
The aim of this study was to assess ocular and mucocutaneous sequelae among SJS/TEN survivors and identify risk factors of ocular sequelae.
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.
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.
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.
本研究旨在评估中毒性表皮坏死松解症/重症多形红斑（SJS/TEN）幸存者的眼部和黏膜皮肤后遗症，并确定眼部后遗症的危险因素。
采用两种方法评估SJS/TEN幸存者的晚期并发症：仅对病历进行回顾性评估，或对病历进行回顾性评估并对通过电话联系的幸存者进行体格检查。
1995年1月至2017年12月，洛美（多哥）的两家大学医院收治了177例SJS/TEN患者（138例SJS，29例TEN，10例SJS/TEN重叠）。其中女性113例，男性64例，平均年龄31.7±13.0岁（范围：5至80岁）。最常用的药物是抗菌磺胺类药物（35.6%）和奈韦拉平（24.3%）。在115例接受检测的患者中，68例（59.1%）HIV血清学呈阳性。在急性期接受眼科医生检查的122例患者中，64例（52.5%）有急性眼部受累，其中27.9%的患者为轻度，13.1%为中度，11.5%为重度。我们记录了17例死亡（即3例SJS、12例TEN和2例SJS/TEN重叠），其中包括11例HIV感染患者。在160例SJS/TEN幸存者中，只有71例患者在出院6个月后接受了评估。其中，43例（60.6%）患者有后遗症。关于黏膜皮肤后遗症，主要病变为弥漫性色素沉着斑（38.0%的患者），眼部后遗症主要为视力下降（14.1%的患者）。多因素分析显示，服用周效磺胺（调整优势比=5.95；95%置信区间=[1.36 - 31.35]）以及急性期眼部中度（调整优势比=5.85；95%置信区间=[1.23 - 31.81]）或重度（调整优势比=48.30；95%置信区间=[6.25 - 1063.66]）受累与眼部后遗症相关。
眼部和黏膜皮肤后遗症在SJS/TEN幸存者中很常见。服用周效磺胺和急性期眼部受累的严重程度是眼部后遗症的危险因素。
