Bilateral Microbial Keratitis in Highly Active Antiretroviral Therapy-induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Case Series

Abstract

Purpose: To report three cases of bilateral microbial keratitis in eyes with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) induced by highly active antiretroviral therapy (HAART) in patients of acquired immune deficiency syndrome (AIDS). Methods: A case series. Results: A detailed clinical examination and systemic review of all the three patients on HAART was performed. While one manifested with the more severe variant of TEN, two of these patients presented with SJS with ocular involvement. Despite withdrawal of nevirapine, the ocular surface disorder persisted. The entailing chronic epitheliopathy along with the compromised immune status led to the development of secondary microbial keratitis in all these cases. Conclusions: The immune reconstitution occurring as a response to the antiretroviral therapy may potentially increase immunologically mediated diseases like SJS and TEN, which in turn may predispose the eye to develop corneal ulcer.

Keywords:

• bilateral microbial keratitis
• HAART
• immune reconstitution syndrome
• Steven Johnson syndrome
• toxic epidermal necrolysis

ACKNOWLEDGEMENT

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.