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.
Highlights
Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are serious drug induced dermatologic occurrences which can be life-threatening at the acute stage [1]
Of the 177 SJS/TEN patients, 17 deaths were recorded in the acute stage including 11 HIV infected patients
Exposure to sulfadoxine and moderate or severe ocular involvement in the acute stage increased the risk of ocular sequelae (Table 3)
Summary
Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are serious drug induced dermatologic occurrences which can be life-threatening at the acute stage [1]. They are considered the most severe types of cutaneous adverse reactions to drugs, with high morbidity and mortality rates [1, 2]. Chronic physical complications among SJS/TEN survivors have been reported in the skin, eyes, oral and genital mucous membranes, gastrointestinal tract, teeth, kidneys, and lungs [3,4,5,6,7]. A previous research identified exposure to sulfadoxine as a factor associated with the severity of the ocular involvement at the acute stage SJS/TEN [8]. The aim of this study was to assess the ocular
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