Background: Stevens-Johnson syndrome (SJS) causes ocular disease in the acute stage and severe visual impairment in the late stage. Severe ocular findings during the acute phase are more likely to be noted when the age of onset is younger, making early, appropriate diagnosis important. Herein, we report the case of a patient who was initially diagnosed with Kawasaki disease by a pediatrician and was later correctly diagnosed with SJS by a dermatologist and an ophthalmologist.
Case report: The patient was an 8-year-old boy who initially presented at Clinic A due to a fever, sore throat, and conjunctival hyperemia in both eyes. Antihistamine agents, expectorants, bronchodilators, antiplasmin agents, and third-generation cephem antibiotics were administered because of presumed common cold-like symptoms. However, his sore throat worsened the following day, and a systemic rash developed over his entire body. He subsequently visited General Hospital B and was admitted with suspected Kawasaki disease. After admission, the on-duty ophthalmologist discovered that he was afflicted with bilateral pseudomembranous conjunctivitis, and he was then transferred to our hospital due to suspected SJS. He was finally diagnosed with SJS due to atypical target-shaped erythema, flare/swelling and erosion of oral/labial mucosa with blood crust and bleed, bilateral pseudomembranous conjunctivitis, and conjunctival epithelial defect. We successfully treated the patient with pulse steroid therapy and the topical administration of betamethasone eye drops, with no continued visual impairment.
Conclusion: Examination by both a dermatologist and an ophthalmologist is useful for the early diagnosis and treatment of SJS.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 705-710, 2018.