Analysis of Ocular Manifestation and Genetic Association of Allopurinol-Induced Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis in South Korea. Issue 2 (February 2016)

• Record Type: Journal Article
• Authors: Lee, Hyo Seok; Ueta, Mayumi; Kim, Mee Kum; Seo, Kyoung Yul; Sotozono, Chie; Kinoshita, Shigeru; Yoon, Kyung Chul
• Is Part Of: Cornea. Volume 35:Issue 2(2016)
• Publication Date: 2016-02
• Subjects: allopurinol -- human leukocyte antigen -- Stevens–Johnson syndrome -- toxic epidermal necrolysis; Cornea -- Periodicals; Cornea -- Periodicals; Cornée -- Périodiques; 617.719
• DOI: 10.1097/ICO.0000000000000708
• Languages: English
• ISSNs: 0277-3740

Abstract

Abstract : Purpose: To describe the clinical characteristics and genetic background of allopurinol-induced Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in South Korea. Methods: This is a prospective, noncomparative case series. Visual acuity, detailed medical history, ocular findings, and systemic manifestations of 5 patients (10 eyes) with allopurinol-induced SJS/TEN were recorded. The acute ocular involvement score and the chronic ocular manifestation score were graded on scales of 0–3 and 0–39, respectively, based on severity. Human leukocyte antigen (HLA) genotyping was also performed during the hospitalization. Results: Three patients were diagnosed with SJS, and 2 with TEN. Mild ocular involvement with only conjunctival hyperemia (acute ocular involvement score ⩽1) was present in all 10 eyes during the acute stage. Patients were treated with systemic steroids and topical antibiotics, steroids, and preservative-free artificial tears, with rinsing of the ocular surface, in the acute stages of SJS/TEN. In the final follow-up, none of the patients had developed severe chronic ocular complications (chronic ocular manifestation score ⩽8), including keratinization, corneal conjunctivalization, mucocutaneous junction involvement, or symblepharon. One patient developed bilateral persistent epithelial defects 3 months after the disease onset, which healed after conservative treatment, leaving a bilateral central corneal haze. HLA genotyping showed that 4 of the 5 patients (80%) were positive for HLA-B*58:01 . Conclusions: Allopurinol-induced SJS/TEN might not cause serious acute or chronic complications of the ocular surface. In addition, our HLA genotyping results are consistent with previous studies reporting a strong association between HLA-B*58:01 and allopurinol-induced SJS/TEN among Koreans.