A Novel Case of Biktarvy-Associated Stevens-Johnson Syndrome With Severe Ocular Involvement

Purpose: The purpose of this study was to describe the first reported case of Stevens-Johnson syndrome (SJS) associated with bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy), highlighting a rare presentation with severe ocular and oral involvement in the absence of cutaneous findings. Case report: A 59-year-old woman developed mucosal-limited SJS 2 weeks after initiating Biktarvy as postexposure prophylaxis. She presented with severe bilateral ocular involvement—characterized by extensive conjunctival and corneal epithelial defects, pseudomembranes, and symblepharon—as well as painful oral ulcerations, but no skin rash. She was treated with topical corticosteroids, antibiotics, and immunomodulators, in addition to multiple amniotic membrane transplants and supportive measures. Persistent corneal epithelial defects were ultimately resolved with cenegermin-bkbj 0.002% therapy. At final follow-up, her visual acuity was 20/20 in both eyes with minimal residual ocular surface damage. Conclusions: This case illustrates an atypical presentation of medication-associated SJS without skin involvement, triggered by a previously unreported agent. Clinicians should recognize that antiretroviral drugs such as Biktarvy may induce SJS and that mucosal-limited disease can cause profound ocular morbidity. Prompt ophthalmologic assessment and early surgical intervention with amniotic membrane transplants are crucial to preserving vision.