A Stevens–Johnson-szindróma és a toxikus epidermalis necrolysis ritka, ugyanakkor igen súlyos bőr- és nyálkahártya-megbetegedést okozó hiperszenzitivitási reakció, amelyet elsősorban gyógyszer, illetve fertőző ágens vált ki. Bár ezek a kórképek potenciálisan életet veszélyeztető állapotot idéznek elő, nem szabad megfeledkezni a szemészeti következményekről sem, amelyek hosszú távon jelentősen befolyásolják az egyén életminőségét. Esetismertetésünk célja felhívni a figyelmet a fenti kórképek szemészeti szövődményeire és a mielőbb megkezdett terápia fontosságára. Az akut fázisban a betegek 50%-ában jelentkezik szemészeti érintettség, ebben az időszakban a nagy mortalitás miatt elveszhet a fókusz a szemészeti intervencióról. Az alábbiakban egy 17 éves beteg esetét ismertetjük, akinél az epilepszia kezelésére alkalmazott lamotrigin toxikus epidermalis necrolysist indukált. Az égési intenzív osztályon töltött, összesen 54 nap első 4 hete rendkívül kritikus volt. A teljes testfelszínre kiterjedő, epidermolysishez társuló szisztémás szövődményeket – mint hypothermia, akut respiratorikus distressz szindróma, szepszis, akut tubularis elhalás, vérszegénység és az elektrolit-egyensúly súlyos zavara – sikeresen kezelték. A betegség szemészeti tüneteit kezdettől fogva jól kontrolláltuk. Két év elteltével a szem elülső szegmentumában nem volt jelentős szövődmény, a látóélesség teljes maradt. Orv Hetil. 2024; 165(31): 1206–1212.
Stevens–Johnson syndrome and toxic epidermal necrolysis are rare but very serious hypersensitivity reactions that cause skin and mucosal disorders, mainly caused by drugs or infectious agents. While this pathology is a potentially life-threatening condition, the ocular consequences should not be overlooked, which may effect the long-term quality of life of the individual. The aim of this case report is to raise awareness of the ophthalmological complications of these conditions and the importance of starting treatment as soon as possible. In the acute phase, 50% of patients present with ocular involvement, during which time the focus may be lost from ophthalmic intervention due to high mortality. In the following, we report the case of a 17-year-old patient in whom the use of lamotrigine induced toxic epidermal necrolysis. The first 4 weeks (54 days in total) were extremely critical. The full-body epidermolysis was associated with systemic complications such as hypothermia, acute respiratory distress syndrome, septicemia, acute tubular necrosis, anemia and severe electrolyte imbalances, which were successfully treated. The ophthalmological symptoms of the disease were well under control from the beginning and were treated intensively and regularly. After two years, there were no significant complications in the anterior segment of the eye, and the visual acuity was fully preserved. Orv Hetil. 2024; 165(31): 1206–1212.
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