Stevens–Johnson syndrome presenting with eyelid ulceration without conjunctival involvement

A 43-year-old male with paraplegia presented to the emergency department with sepsis secondary to decubital ulcers with sacral osteomyelitis. He was treated with broad spectrum intravenous antibiotics including sulfamethoxazole/trimethoprim. On day 3 of treatment, he developed bilateral upper eyelid skin ulceration and hyperpigmentation. Conjunctival examination was within normal limits. His ulceration was suspected to be secondary to Stevens-Johnson syndrome (SJS). Sulfamethoxazole/trimethoprim was discontinued and the patient's eyelid ulceration fully resolved within 72 h, supporting the diagnosis of SJS. Skin hyperpigmentation fully resolved within two weeks. To the authors’ knowledge, this is the first case in the English literature of SJS with eyelid ulceration without conjunctival involvement.