Stevens Johnson Syndrome

Stevens Johnson Syndrome

• 1.
  Dr. Md. RezwanulHasan DO Student Rangpur Medical College Hospital Rangpur
• 2.
  Particulars of Patient Name : Mrs. Ashia  Age : 50 yrs  Sex : Female  Occupation : Housewife  Marital status : Married  Address : Johurdanga, Sadar Thana, Rangpur  Date Of Admission : 21.01.17  Date Of Examination : 25.01.17
• 3.
  Chief Complaints  GradualDimness of vision for 3 yrs  Dryness and foreign body sensation for same duration.
• 4.
  History of presentillness  According to the statement of the patient, she was resonabley well 3 yrs back. Then she got typhoid fever and after starting medication she got bullous leisions all over her body.  Following recovery of typhoid fever, she suffered in gradual dimness of vision.  She also complaints dryness and foreign body sensation in her both eyes.  She gives no history of diplopia.
• 5.
  Cont…  With thesecomplaints she consulted with near by ophthalmologist several times.  She was referred to Rangpur Medical College Hospital for better management.
• 6.
  Past Ocular History No history of trauma.  No history of use of spectacles.
• 7.
  Medical and surgicalhistory  Medical - She suffered in typhoid fever 3 yrs back and treated accordingly.  Surgical – No surgical history
• 8.
  Family History  Noother family members are suffering from any ocular or systemic disease related to present complaint
• 9.
  Drug History  Shegave history of drug reaction during treatment of typhoid fever 3yrs back.  She was treated by severals drugs for present complaint but cann’t mention the names.
• 10.
  Review of othersystems  Respiratory system, cardiac system, Nervous system, Genitourinary system, Gastrointestinal system and other systems reveals no other abnormality.
• 11.
  General Examination  Appearance– Ill looking  Anemia  Jaundice Absent  Cyanosis  Patient – Cooperative  Lymph node – not palpable  Pulse – 76/min  BP – 110/70 mmHg
• 12.
  Ocular Examination  VISUALACUITY  R/E : unaided – 6/60 pinhole – 6/36 not improved with refraction  L/E : unaided – 6/60 pinhole – not improved not improved with refraction  Color vision – Trichromatic both eye  Field of vision – Normal in Rt eye Mild restriction in nasal field in Lt eye
• 13.
  External Examination  Inspection 1.Head posture - normal 2. Symmetry of the face - normal 3. Eye brow & fore head - normal 4. Eye lids – Thickened 5. Palpebral fissure - Narrow 6. Position of the eyeball - Normal  Hirschberg’s light reflex – Central in both eyes  Ocular motility – Mildly reduced in medial gaze in Lt. eye  Pupil – size: 4mm in normal room light
• 14.
  Slit Lamp Examination RightEye Left Eye Eyelids Thickened Thickened Eye Lashes Trichiasis and Distichiasis Trichiasis and Distichiasis Conjunctiva Dry and lusterless, Shortening of upper and lower fornices due to adhesion between bulbar and palpebral conjunctiva Dry and lusterless, Shortening of upper and lower fornices due to adhesion between bulbar and palpebral conjunctiva Cornea Opacity and vascularization present in all around the limbus Opacity and vascularization present in all around the limbus A/C Normal in depth and content Normal in depth and content Iris Normal Normal Pupil Center, circular, brisk Center, circular, brisk
• 15.
  Ophthalmoscopy  Could notdone due to hazy media.
• 16.
  Salient Feature  Thepatient Mrs. Ashia, 50yrs old housewife hailing from Johurdanga, Sadar Thana, Rangpur, got admitted in Rangpur Medical College, Hospital on 21.01.2017 with the complaints of gradual dimness of vision, foreign body sensation and dryness for 3yrs. She gave history of drug induced allergic reaction during medication for typhoid fever 3yrs back which involved eruption of bullous leisions all over her body. She is non diabetic, non hypertensive and other systemic examinations reveals no abnormality.
• 17.
  Cont…  On ocularexamination her V/A Rt eye 6/60 with P/H 6/36, Lt eye 6/60 with P/H not improved. Mildly reduced ocular motility in medial gaze in Lt eye with restricted nasal field of vision in same eye. Rt eye is normal.  On slitlamp examination, eyelids are thickened, trichiasis and distichiasis present in both eyes. Conjunctiva dry and lusterless with shortening of upper and lower fornices due to adhesion between bulbar and palpebral conjunctiva by fibrous band in both eyes.
• 18.
  Cont…  Opacity andvascularization present in all around the limbuses of both corneas. A/C is normal in depth and content. Lenses are mildly opaque in both eyes. Posterior segment could not be visualized due to hazy media.
• 19.
  So…  My diagnosisis ocular surface disorder due to Stevens- Johnson Syndrome.
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  THANK YOU ALL