Corneal Perforation Caused by Noninfectious Corneal Ulcer in a Patient with Toxic Epidermal Necrolysis

ABSTRACT

PURPOSE: To report a case of corneal perforation caused by non-infectious corneal ulcer in a patient with toxic epidermal necrolysis (TEN). METHODS: A 29-year-old female visited the hospital with bullous lesions on the erythematous body surface. She also had severe conjunctivitis and keratitis in both eyes. She had been taken antibiotics and analgesics for nasopharyngitis. The patient was diagnosed with TEN. Although she was hospitalized and treated in the department of internal medicine, the left cornea was severely necrotized and became thinner. Slit-lamp examination showed focal descematocele in the central cornea. The result of corneal culture was negative and corneal infiltration that would suggest an infectious ulcer was not observed. RESULTS: The patient was in poor general health because of pneumonia. We performed tectonic amniotic membrane transplantation to prevent corneal perforation. Fibrovascular tissues were growing on the amniotic membrane from the surrounding conjunctiva. However, they did not cover the descemetocele area. Her general condition continued to worsen and she was transferred to the intensive care unit. The cornea was perforated and the patient died of septic shock. CONCLUSIONS: Corneal perforation may occur in a patient with TEN without secondary bacterial infection. Therefore, patients with TEN need to be informed of this serious complication and the possible need for more intensive treatment.