COMPLEX OPHTHALMIC AND SYSTEMIC MANAGEMENT IN A PATIENT WITH SEVERE STEVENS-JOHNSON SYNDROME: A CASE STUDY

This case study aims to explore the complex clinical management and outcomes in a patient with severe Stevens-Johnson Syndrome (SJS) who underwent multiple penetrating keratoplasties (PK) and faced significant ocular and systemic complications.

The case involves a 42-year-old male with a history of SJS, hepatitis C, tuberculosis, and recurrent sepsis. The study highlights a multidisciplinary approach in managing SJS-related ocular conditions, involving ophthalmologists, infectious disease specialists, and intensivists.

The patient, who experienced severe ocular surface disease and progressive visual loss, underwent five PKs in the right eye and three in the left eye, due to recurrent graft failure and chronic inflammation. He also received multiple amniotic membrane patches and anti-glaucoma medications to manage elevated intraocular pressure (IOP). Concurrent systemic conditions necessitated strict medical adjustments.

Despite extensive surgical and medical interventions, the patient experienced recurrent graft failure due to chronic inflammation and a compromised ocular surface. Secondary glaucoma developed in both eyes, leading to further vision impairment. Systemic complications, including tuberculosis, hepatitis C, and recurrent sepsis, complicated his immunosuppressive regimen, delaying ocular surgeries and exacerbating his condition. Temporary improvements were achieved with intensive care and surgical adjustments, but the prognosis remained guarded.

This case underscores the challenges in treating SJS with extensive ocular involvement, especially when compounded by systemic diseases. Recurrent graft failure, secondary glaucoma, and infections highlight the necessity of a multidisciplinary approach. The study emphasizes early intervention and continuous management to mitigate severe complications, although long-term success is limited in complex cases like this.