TABLE 1.
Disease Time Course and Events Before and After Hospital Admission
| Time Course (Days) | Events |
|---|---|
| Pre-hospital | |
| 1 | Night fevers; no medicationsa |
| 3 | Fevers resolve; no medications |
| 7 | Presented with bilateral purulent conjunctivitis and oral tongue ulcer; diagnosis of bacterial conjunctivitis; discharged with ofloxacin and cefdinir eye drops |
| 12 | Presented with more oral ulcers and worsening conjunctivitis; diagnosis of Cocksackievirus; ofloxacin and cefdinir discontinued and Magic Mouthwashb started |
| 14 | Presented with odynophagia and severe conjunctivitis; diagnosis of herpes-simplex virus gingivostomatitis with conjunctivitis or Stevens–Johnson syndrome; Magic Mouthwash discontinued and empiric intravenous acyclovir started |
| Hospital | |
| 1 | Presented with bilateral non-limbic–sparing conjunctivitis with symblepharon; started artificial tears, Lacri-Lube, prednisolone acetate, and tobramycin-dexamethasone drops |
| 3 | Underwent lip and oral mucosa biopsy, dilated funduscopic examination under anesthesia, symblerpharon lysis, and amniotic membrane transplantation; no herpetic lesions or corneal epithelial defects were found; started artificial tears, Lacri-Lube, 0.05% cyclosporine, 0.5% moxifloxacin, and 0.1% dexamethasone |
| 4 | Acyclovir discontinued, intravenous immunoglobulin started |
| 6 | Intravenous immunoglobulin discontinued |
| 11 | Patient discharged |
| 6-week follow-up | Bilateral white and quiet eyes |
a
No ibuprofen, acetaminophen, or other medication was taken for fevers as per the patient’s mother.
b
Magic Mouthwash formulation contained nystatin, diphenhydramine, Mylanta, viscous lidocaine 2%, and distilled water.
Magic Mouthwash is manufactured by CutisPharma, Inc., Wilmington, MA; Lacri-Lube is manufactured by Allergan, Dublin, Ireland; and Mylanta is manufactured by McNeil Consumer Pharmeuticals Co., Lancaster, PA.