Conjunctival pigmentation in Stevens-Johnson syndrome

Area of Science:

• Ophthalmology
• Dermatology
• Pathology

Background:

• Stevens-Johnson syndrome (SJS) is a severe mucocutaneous reaction often triggered by medications.
• Conjunctival involvement in SJS can lead to significant ocular morbidity.
• Drug-induced hypersensitivity reactions require thorough investigation of ocular sequelae.

Observation:

• A 29-year-old female presented with bilateral conjunctival pigmentation following a sulfasalazine-induced SJS episode.
• The pigmentation was observed on the tarsal and forniceal conjunctiva, appearing black in color.
• Histopathological examination revealed stromal monocyte infiltration and pigment of melanic origin.

Findings:

• The conjunctival pigmentation was confirmed to be of melanic origin, not directly from drug deposition.
• Biopsy findings were consistent with the chronic phase of Stevens-Johnson syndrome.
• Despite treatment with topical steroids and artificial tears, the pigmentation remained unchanged after two years.

Implications:

• Conjunctival pigmentation may be a long-term sequela of Stevens-Johnson syndrome.
• The melanic origin suggests a potential inflammatory or post-inflammatory process affecting melanocytes.
• Further research is needed to understand the pathogenesis and potential management strategies for SJS-related conjunctival pigmentation.