Abstract
Abstract To report a case of peripheral corneal thinning with a presentation similar to a Mooren’s ulcer but with pathology consistent with cicatricial pemphigoid. We report the case of a 56-year-old woman who presented with unilateral peripheral corneal thinning. Before presentation, the patient was treated with prednisone 60 mg daily, an amniotic membrane, and artificial tears. The patient denied any prior autoimmune history. The left cornea had nasal crescentic corneal thinning 6.0 mm tall and 1.5 mm wide. Visual acuity was 20/40 uncorrected in the involved eye. Initial laboratory workup was notable for a low positive rheumatoid factor and positive fluorescent treponemal antibody absorption but negative rapid plasma reagin. Corneal cultures were negative. The patient was started on oral and topical steroids, topical moxifloxacin, and mycophenolate mofetil and underwent a conjunctival resection. The conjunctival tissue was sent for pathology and was notable for strong deposits of immunoglobulin G at the epithelial basement membrane consistent with mucous membrane pemphigoid. Mycophenolate mofetil was discontinued due to oral thrush. Due to persistent activity, she underwent repeat conjunctival resection with the placement of an amniotic membrane over the area of thinning. She was subsequently started on rituximab biosimilar infusions and tapered off prednisone. Visual acuity at the last follow-up was 20/25. While conjunctival resection is a potential management option for Mooren’s ulcer, routine conjunctival biopsy for pathology is not. Our case highlights a potential overlap between the pathophysiology of ocular cicatricial pemphigoid and Mooren’s ulcer. Sending conjunctival tissue for pathology could provide benefits to the underlying mechanisms of different variants of Mooren’s ulcer.
Published Version
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