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[Lyell's disease--a case report]
R Kiszová1, D Cholevík, J Timkovic
1Ocní klinika, FN Ostrava. kiszova.radka@seznam.cz
Summary
Lyell's disease (Stevens-Johnson syndrome/toxic epidermal necrolysis) can cause severe eye complications. This case report details managing ocular issues, including symblepharon, in a teen following lamotrigine-induced skin reactions.
Area of Science:
- Dermatology
- Ophthalmology
- Pharmacology
Background:
- Lyell's disease, a severe mucocutaneous reaction, is often drug-induced and lacks specific treatments.
- Ocular involvement is common and can lead to significant visual impairment.
- Interdisciplinary care is crucial for managing this life-threatening condition.
Observation:
- A 15-year-old male presented with Stevens-Johnson syndrome (SJS) / toxic epidermal necrolysis (TEN) secondary to lamotrigine.
- He experienced extensive skin involvement (85% body surface area) and severe ocular manifestations, including symblepharon.
- Initial mild ocular symptoms progressed to severe adhesion, impacting the puncta.
Findings:
- Treatment involved topical antibiotics, corticosteroids, lubricants, and mechanical lysis of symblepharon.
- Despite treatment, the patient developed persistent symblepharon obstructing the puncta in both eyes.
- Long-term follow-up revealed no corneal abnormalities or fornix shortening, with minimal discomfort.
Implications:
- This case highlights the severe ocular sequelae of drug-induced SJS/TEN, even with prompt management.
- Effective management requires a multidisciplinary approach, focusing on preventing further adhesion and preserving ocular surface.
- Long-term ophthalmological monitoring is essential to manage chronic complications like punctal obstruction.
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