Ophthalmologic Manifestations in a Patient with Allopurinol-induced Toxic Epidermal Necrolysis

Abstract

Toxic epidermal necrolysis and Stevens Johnson syndrome are clinical variants of the same disease, which is defined as a vesicular erythema multiforme of the skin and other organs. It is considered to be the initial stage of a dermal reaction whose most severe form of presentation is toxic epidermal necrolysis. It manifests as an acute inflammatory systemic reaction involving more than 30% of the body surface. The most important clinical finding is maculopapillary lesions that spread centripetally and evolve into confluent vesicles, usually affecting the oral mucosa, conjunctival and genital area. Stevens Johnson syndrome occasionally evolves to toxic epidermal necrolysis, is characterized by intense pain and loss of the epithelial surface, compromising the vital functions of the organism, causing a hydroelectrolytic imbalance, renal and ocular compromise, a great catabolism and a potential risk of sepsis, being drugs the most frequent etiologic agent. The 50-67 % of patients with toxic epidermal necrolysis present ocular affectations, among the most common are membranous and pseudomembranous conjunctivitis, as well as symblepharon formation. A case of adverse drug reaction is presented in a 49-year-old male patient, with a history of systemic lupus erythematosus, arterial hypertension and hyperuricemia, who was treated at the Clinical-Surgical Hospital Hermanos Ameijeiras for presenting multiform erythematous skin lesions and ophthalmologic manifestations, after having started treatment with allopurinol.