title: Bilateral microbial keratitis in highly active antiretroviral therapy-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: a case series.
abstract: OBJECTIVE
  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.
authors.affiliation: Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ritika
authors.initials: R
authors.lastname: Sachdev
authors.forename: Shubha
authors.initials: S
authors.lastname: Bansal
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sinha
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
authors.forename: Jeewan S
authors.initials: JS
authors.lastname: Titiyal
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000328:Adult; D000650:Amnion / Q000637:transplantation; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001372:Aza Compounds / Q000627:therapeutic use; D001550:Benzamidines / Q000627:therapeutic use; D002266:Carboxymethylcellulose Sodium / Q000627:therapeutic use; D002437:Cefazolin / Q000627:therapeutic use; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000139:chemically induced* / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D010146:Pain / Q000139:chemically induced / Q000382:microbiology; D011804:Quinolines / Q000627:therapeutic use; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced* / Q000382:microbiology*; D014031:Tobramycin / Q000627:therapeutic use; D016896:Treatment Outcome; D014326:Tropanes / Q000627:therapeutic use; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D001550:Benzamidines; D024841:Fluoroquinolones; D011804:Quinolines; D014326:Tropanes; C046651:propamidine isethionate; C100236:homatropine; D002437:Cefazolin; D002266:Carboxymethylcellulose Sodium; C010882:chlorhexidine gluconate; D002710:Chlorhexidine; D000077266:Moxifloxacin; D014031:Tobramycin