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Jeanie Ling, Cherie Fathy, Sahar Kohanim; Pediatric Erythema Multiforme, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis: epidemiology and risk factors for ocular involvement. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1537.
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© ARVO (1962-2015); The Authors (2016-present)
Erythema Multiforme (EM), Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) have high morbidity and mortality and represent a spectrum of adverse reactions to drugs and infections. Eye involvement ranges from minimal to severe with both acute and chronic sequelae. There is a paucity of literature regarding pediatric patients with these conditions. We describe the epidemiology of pediatric EM/SJS/TEN and identify predictors for eye involvement in our cohort.
We performed a retrospective cohort study over 10 years using Vanderbilt’s Synthetic Derivative Database of de-identified patient records. Subjects age <18 years at presentation with ICD-9 diagnoses of cutaneous reactions were included. Manual chart review was used to confirm diagnosis. The main outcome measure was eye involvement. Covariates included age of onset, sex, race, etiology, affected body surface area (BSA), systemic diagnosis, oral or genitourinary involvement, length of hospitalization, histologic features, inflammatory serum markers, season of onset, recurrence, and use of IVIG. Initial and final visual acuity were included. Bivariate as well as multivariable analysis using multiple logistic regression were used to identify independent risk factors for eye involvement.
48 children were included 6 had recurrent disease. The mean age at presentation was 8.89±4.68 years. 54.17% were female and 81.25% were Caucasian. Most cases were drug-related and occurred in fall/winter. 36 children developed eye involvement. In both bivariate and multivariable analysis, longer hospital stay (p=0.004), presence of oral involvement (p=0.013), and severity of diagnosis (p=0.047) were independent risk factors for the development of ocular involvement.
Oral mucosal involvement, severity of diagnosis, and longer hospitalization are associated with increased risk of eye involvement in pediatric patients with EM/SJS/TEN. A repeat eye examination should be considered in children with these risk factors, even with normal initial eye exam.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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