Clinical Analysis Of Severe Drug Eruption With Ocular Complications

OBJECTIVEOcular complications in severe drug eruption may frequently occur acutely along with the onset of skin involvement. Severe ocular complications may even result in permanent visual loss. Little is currently known about the ocular symptoms of severe drug eruption. This study aimed to reviewed the clinical features and the laboratory findings of severe drug eruption with ocular complications, and to get the possible clinical predictors associated with the risk for the development of ocular complications.METHODSA total of 66 cases with ocular complications were collected from our hospital from 2001 to 2009. They were divided into the mild group and severe group by the severity of the ocular complications and evaluated retrospectively. The clinical manifestations and laboratory findings of the 2 groups were recorded and analyzed, a retrospective cohort study was made.RESULTSAs compared with the patients with mild ocular complications, the severe cases had higher temperatures (39.4℃vs.38.7℃, P＜0.01), and more common to have diffuse involvement of mucous membrane just like oral cavity (100%vs.80%, P<0.05), both oral cavity and perineum (61.5%vs.40.0%, P<0.01). As well,the severe group had larger average dosage of glucocorticoids(3.3 mg-kg-1·d-1), higher percentage of intravenous immunoglobulin (100%)and more length of hospital stay (23.08 d) than those in the mild one(2.6 mg-kg-1·d-1,50.0%,18.75d) (P<0.05 or P<0.01).According to the laboratory findings, not only the absolute neutrophil count (7.29*103/μl in the severe group vs.4.06*103/μl in the mild), percentage of neutrophilic granulocyte (77.49%in the severe group vs.58.17%in the mild)or globulin (3.03g/dl in the severe group vs.2.70g/dl in the mild), but also the albumin/globulin (1.14 in the severe group vs.1.31 in the mild)and urine protein (0.49g/l in the severe group vs.0.17g/l in the mild)showed significant differences btween the 2 groups. Meanwhile, numbers of immunoglobulin in the severe group just like IgG(16.64g/l), IgA(3.14g/l) and IgM(1.75g/l), were larger than those in the mild (11.87g/l,2.3g/l, 1.00g/l)(P<0.05). Obvious difference was also be shown in occult blood (P<0.01).Logistic Regression analysis showed that the occult blood(OB) in stool and absolute neutrophil count (N) should be the predictors which associated with the risk for the ocular complications.CONCLUSIONSOcular involvement is common in patients with severe drug eruption. There is a significant relation between the ocular complications and the humoral immune reaction. Occult blood (OB) and absolute neutrophil count (N) should be the significant predictors associated with the risk of severe ocular complications.