Case Of Peripheral Ulcerative Keratitis Research Articles

Peripheral Ulcerative Keratitis Secondary to the Inactive COVID-19 Vaccine-CoronaVac

ABSTRACT Purpose To report a case of peripheral ulcerative keratitis (PUK) secondary to the inactive Covid-19 vaccine. Methods The case of a 67-year-old man who presented with unilateral progressive vision-threatening PUK with nodular scleritis was reported. The results of clinical examinations with surgical and medical treatments were noted. Results The extended workup for autoimmune and infectious etiologies for PUK that all returned negative. The patient was treated with oral steroids, azathioprine, and topical cyclosporine with topical dexamethasone for his PUK and underlying possible immunopathology. Corneal amniotic membrane grafting was also performed 4 times and finally, the patient underwent penetrant keratoplasty for visual rehabilitation. Conclusions To our knowledge, we report the first case of PUK that is possible to secondary to an inactive vaccine for SARS-CoV-2. The inactive covid vaccine should be considered as an etiological agent in PUK cases where the standard workup is negative.

A Vision- and Life-threatening Case of Peripheral Ulcerative Keratitis

A Vision- and Life-threatening Case of Peripheral Ulcerative Keratitis

A case of peripheral ulcerative keratitis associated with limited granulomatosis polyangiitis

A 28-year-old Indian female presented with sudden onset reduced vision and pain in the left eye following blunt trauma. There was chronic history of redness, tearing, and irritation in both the eyes. She was diagnosed with peripheral ulcerative keratitis and corneal perforation in the left eye. Her corneal perforation was repaired with direct closure. Diagnostic workup revealed limited granulomatosis polyangiitis. The patient was treated with topical and systemic steroids and immunosuppressant drugs (rituximab).

Peripheral Ulcerative Keratitis Associated with HCV-Related Cryoglobulinemia

Purpose To describe a case of peripheral ulcerative keratitis associated with type II cryoglobulinemia in the context of Hepatitis C infection. Methods Case report and literature review. Results A 36-year-old male patient presented to our emergency department with unilateral moderate pain in his right eye, associated with redness and photophobia. Medical background elicited a history of Hepatitis C and IV illicit drug abuse. Ocular examination revealed a BCVA of 20/30 of the affected eye and slight discomfort with eye movement. Biomicroscopy revealed a ring shaped peripheral corneal ulcer, with a dense white stromal infiltrate sparing the limbus, plus an adjacent area of mild anterior diffuse nonnecrotizing scleritis. No intraocular inflammation was present. Posterior segment was normal. The patient was placed under oral prednisolone (1 mg/Kg/day) with gradual tapering. A dramatic clinical response occurred, with complete resolution of the clinical condition. Systemic analytic workup aiming at autoimmune and infectious diseases was negative, except for high HCV-viral load and the presence of type 2 cryoglobulins. Conclusion Albeit rare, cryoglobulinemia, even in the absence of systemic vasculitis, should be considered in the differential diagnosis of PUK, when systemic workout for autoimmune diseases is negative.

A case of peripheral ulcerative keratitis after cross-linking for keratoconus

We aimed to introduce a case of peripheral ulcerative keratitis occuring after cross-linking for the treatment of keratoconus in this study. A female diabetic patient, 38 year-old, was admitted to our clinic in September 2011. Her cycloplegic refraction was -1.00 -3.75 48 in her right eye and -2.00 -4.50 144 in her left eye. Her visual acuity was 0.4/ 0.1 with and without correction. Her keratometry was measured as 46.12 50.62 139 in her right eye and 46.75 53.62 54 in her left eye. After 17 months she was admitted to our clinic again and she gave a history of cross-linking in her both eyes 3 weeks ago. The patient complained of pain, blurry vision and hyperemia in her both eyes. She had been treated with antibiotic drops, artificial tears, corticosteroid drops and contact lenses for 4 monthts, but no improvement could be recorded. In contrast epithelial defects, infiltrates and thinning were detected in the periphery of both corneas. Because the systemic steroids caused dysregulation of blood glucose level, Azathioprine was preferred. Pathologic findings ameliorated with this drug, but it had to be stopped because of economical reasons. The complaints recur sometimes and are treated with topical drugs. The patient stil has a ring opacity in her both eyes. The doctors interested in the cross-linking treatment of keratoconus should be careful about the diabetes mellitus. If peripheral ulcerative keratitis is detected in such a case it can be treated with systemic immune suppressive drugs.

A rare case of peripheral ulcerative keratitis associated with Behçet’s disease

We report a rare case of peripheral ulcerative keratitis (PUK) associated with Behçet's disease. A 34-year-old female presented with right ocular pain persisting for 8 months. The patient had been treated for previously diagnosed Behçet's disease. The corrected visual acuity was 20/32 in the right eye. Ocular examination revealed mild conjunctival hyperemia and a deep ulcerative lesion with perilesional haziness in the peripheral cornea. Autoimmune screening and corneal culture were negative. One month following treatment with topical and systemic immunosuppressants, the symptom had resolved. Slit-lamp examination showed a healed corneal lesion, and visual acuity improved to 20/20. Despite its rare occurrence, PUK can develop in patients with Behçet's disease. Therefore, patients presenting PUK require examination for Behçet's disease using a systemic evaluation.

A Case of Peripheral Ulcerative Keratitis as Primary Herpes Simplex Infection in a Child

Purpose: To report a case of peripheral ulcerative keratitis in a case of primary herpes simplex infection. Case summary: A 7-year-old male complaining of pain, redness, and decreased vision in the left eye 5 days in duration visited our clinic. The patient had also vesicular lesions over the edematous left upper eyelid. Slit-lamp examination revealed peripheral ulcerative keratitis with stromal infiltration involving the superior peripheral cornea. Corneal sensation in the left eye was decreased. The patient was advised to use topical and oral antiviral agents and a topical steroid. After 5 days of follow-up, the corneal lesions were decreased and vesicles were absent. Six months later, only minor opacities remained in the cornea. Conclusions: We report the first case report in Korea of peripheral ulcerative keratitis with blepharoconjunctivitis presented as primary herpes simplex infection which responded to antiviral and steroid treatment in a young male. J Korean Ophthalmol Soc 2014;55(5):761-765

A Case of Peripheral Ulcerative Keratitis and Scleritis in a Patient with Pustular Psoriasis

Purpose: To report a case of peripheral ulcerative keratitis and scleritis in a patient with pustular psoriasis. Case summary: A 62-year-old male presented with skin lesions on the hands and feet and pain in the right eye, which started a few days prior. Corrected visual acuity was 0.5 in the right eye and 0.7 in the left eye at initial visit. Corneal edema, erosion, ulcer and peripheral corneal infiltration of the right eye were observed. However, anterior chamber reaction was not observed. Histological analysis of hand skin lesions indicated pustular psoriasis. The patient was initially treated with topical antibiotics and a combined therapy of oral and topical steroids for ocular symptoms. As a result, the right eye showed slight improvement and the oral steroid was discontinued. One month after the initial visit, scleritis appeared on the left eye and topical and oral steroids were restarted for both eyes. Two months after the initial visit, ocular symptoms were improved significantly and corrected visual acuity was 1.0 in both eyes. The mild peripheral corneal opacity remained in the right eye, but the previous inflammations in both eyes were improved. Conclusions: As shown in this case, possibility of peripheral corneal infiltration, corneal ulcer and scleritis should be considered in patients with pustular psoriasis and topical and systemic steroids should be administered if accompanying ocular manifestations occur. J Korean Ophthalmol Soc 2014;55(6):913-917

An unusual case of peripheral ulcerative keratitis as a presenting feature in an otherwise healthy patient with undiagnosed human immunodeficiency virus infection and low CD4 counts

Sir, Peripheral ulcerative keratitis (PUK) as initial manifestation in a patient with asymptomatic human immunodeficiency virus (HIV) infection is rarely reported. Herein, we describe HIV vasculitis presenting as PUK in an otherwise healthy HIV-infected patient. A 40-year-old married female presented with right eye redness, blurring of vision and pain since 1 month with no history of trauma, discharge, watering or contact lens wear without any complaints in left eye and no significant systemic history. The best corrected visual acuity was 20/40 and 20/20 in the right and left eyes, respectively. On slit lamp examination, the right eye showed a crescentic lesion involving the nasal corneal margin from 1 to 5 o′clock in the clockwise direction with associated stromal thinning; conjunctival involvement in the form of nodular lesion with dilated tortuous vessels and underlying scleral thinning [Fig. 1]. Ocular adnexa, corneal sensations and dilated fundus examination of both eyes were normal. Figure 1 Right eye showing a crescentic lesion nasally with associated stromal thinning, conjunctival involvement and underlying scleral thinning With an impression of PUK, the patient was advised the following investigations: erythrocyte sedimentation rate (ESR), rheumatoid arthritis factor, antineutophil cytoplasmic antibody, Venereal Disease Research Laboratory test, counselled enzyme-linked immunoassay (ELISA) for HIV, X-ray chest, Mantoux test and rheumatologist opinion. Corneal scraping was subjected to Gram and Giemsa stains, KOH mount and culture and sensitivity, and was reported to be negative. Rheumatology opinion showed no clinical evidence of collagen vascular disorder. All blood investigations, Mantoux test (4 mm induration), ESR (15 mm) and X-ray chest were normal. ELISA for HIV was reported to be positive. The patient was started on lubricant drop and referred to the HIV clinic. CD4 counts (110 cells/cu mm) and viral load by polymerase chain reaction (PCR) (163,960 copies/mL) were done and the patient was started on anti-retroviral therapy (ART) – (zidovudine 300 mg BD, lamivudine 150 mg BD and efavirenz 600 mg OD). Impression cytology of the lesion showed inflammatory cells (neutrophils and lymphocytes) suggesting an active disease process. Scraping was repeated and PCR done for herpes simplex virus 1 and 2 and herpes zoster virus, and was negative. The lesion that initially showed worsening after starting ART (immune recovery response) showed almost complete resolution over the next 2 months, with minimal residual subconjunctival scarring [Fig. 2]. Figure 2 Right eye showing almost complete resolution of the lesion with minimal subconjunctival scarring at 8 weeks follow-up PUK with central retinal vein occlusion[1] and PUK secondary to ocular surface infection with herpes zoster virus[2] have been previously reported in the literature as presenting feature of HIV infection. Our patient had no history of chicken pox, no evidence of herpes zoster or any systemic condition known to be associated with PUK in HIV infection. Vasculities in HIV infection is an uncommon but important pathogenic factor that might manifest as organ-based disease process. HIV vasculopathy is an indirect effect of HIV infection via the immune complex-mediated mechanism or direct infection of vascular/perivascular tissue.[3] Negative serological and microbiological tests, simultaneous involvement of cornea, conjunctiva and sclera,[4] acute inflammatory cells on impression cytology, a high viral load with low CD4 counts and excellent resolution with ART led us to suspect HIV vasculopathy as a possible pathogenesis in our patient. Further research will help us determine the exact pathogenesis in these types of cases.

A Case of Peripheral Ulcerative Keratitis in a Patient with Rheumatoid Arthritis

pISSN: 2093-940X, eISSN: 2233-4718 Copyright c 2012 by The Korean College of Rheumatology This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited. Figure 1. Slit lamp examination of the right eye shows a peripheral corneal ulcer (black arrow) and adjacent corneal neovascularization (white arrow). Figure 2. Deformities due to longstanding rheumatoid arthritis are shown on hand x-ray. A Case of Peripheral Ulcerative Keratitis in a Patient with Rheumatoid Arthritis

Peripheral Ulcerative Keratitis Associated with Multiple Myeloma

Corneal involvement in multiple myeloma (MM) is rare. We would like to report a first case of peripheral ulcerative keratitis (PUK) associated with MM which improved on systemic corticosteroid treatment.

Peripheral Ulcerative Keratitis After Cataract Surgery in a Patient With Ocular Cicatricial Pemphigoid

To describe a case of peripheral ulcerative keratitis (PUK) that developed in the immediate postoperative period after uncomplicated cataract surgery in a patient with ocular cicatricial pemphigoid. Single interventional case report. An elderly white woman with stable ocular cicatricial pemphigoid underwent an uncomplicated clear corneal phacoemulsification procedure in the left eye. In the immediate postoperative period, PUK developed adjacent to the corneal wound in the left eye. The PUK was successfully treated with a bandage contact lens to the left eye, optimizing the ocular surface with punctal plugs and topical and systemic steroid therapy. After a 7-week course of tapering topical and systemic steroids, the PUK completely resolved. There was no further flare-up over a 12-month period. PUK can develop after clear corneal cataract surgery in patients with stable ocular cicatricial pemphigoid. Perioperative immunosuppression should be considered to minimize the chance of PUK developing in such cases.

A case of peripheral ulcerative keratitis associated with neutrophilic dermatosis of the dorsal hand

We report a case of peripheral ulcerative keratitis associated with neutrophilic dermatosis of the dorsal hand, a recently described clinical entity. A 68-year-old man presented with concurrent peripheral ulcerative keratitis of the right eye and neutrophilic dermatosis of the dorsal hand causing pustular skin eruptions on the dorsal surface of both hands. Systemic investigations suggested an underlying diagnosis of Wegener's granulomatosis. To our knowledge this is the first reported case of neutrophilic dermatosis of the dorsal hand associated with ocular complications.

A Rare Case of Peripheral Ulcerative Keratitis in Temporal Arteritis

To present a case of peripheral ulcerative keratitis (PUK) that progressed to corneal perforation in the setting of recently diagnosed temporal arteritis. A 76-year-old man presented with a 2-week history of red eye and gradual loss of vision in the right eye. His medical history included recently diagnosed temporal arteritis without previous eye involvement. Clinical examination revealed severe peripheral corneal melting leading to corneal perforation. The patient was treated in the acute phase with topical dexamethasone drops and oral prednisolone. Perforation was sealed with cyanoacrylate glue. Azathioprine was also administered. Inflammation was resolved and his eye remains quiet. To our knowledge, this is the first reported case of PUK in the background of temporal arteritis.

Peripheral ulcerative keratitis with bilateral optic nerve involvement as an initial presentation of acute lymphocytic leukemia in an adult

To report a case of peripheral ulcerative keratitis (PUK) and scleritis, along with bilateral optic nerve infiltration as an initial presentation of acute lymphocytic leukemia (ALL) in an adult. Observational case report. A 24-year-old patient presented with complaints of pain, redness, and watering in the right eye since 15 days along with progressive decrease of vision since 3 months, leading to bilateral blindness. On examination, the visual acuity was absence of light perception in both eyes. Examination of the right eye revealed a PUK and adjacent localized scleritis. Fundus examination revealed bilateral multiple flame-shaped retinal haemorrhages. The optic discs in both eyes showed pallor with blurred margins. B-scan ultrasonography revealed bilateral optic nerve thickening. Head computed tomography was normal. Blood picture and bone marrow examination revealed features consistent with ALL. For sclerokeratitis, the patient was recommended topical steroids along with adjuvant therapy. She was referred to the oncology services for management of leukemia and was treated with chemotherapy. The sclerokeratitis responded well to medical management. However, no gain in vision could be achieved. ALL can present with sclerokeratitis and bilateral blindness due to optic nerve infiltration in an adult. Early diagnosis and prompt management may save the patient from blindness.

Peripheral Ulcerative Keratitis and Central Retinal Vein Occlusion as the Initial Manifestation of HIV Infection

Purpose: To report a case of peripheral ulcerative keratitis and central vein occlusion as the initial manifestation of HIV infection. Method: Case report. Result: A 46-year-old male presented with history of pain, redness, and diminished vision of left eye. Examination revealed left eye peripheral ulcerative keratitis (PUK) and right eye central retinal vein occlusion (CRVO). The patient was found to be positive for HIV on serological evaluation. Conclusion: Atypical ophthalmic manifestations may be the initial presenting feature in patients with HIV infection. This highlights the need for increased index of suspicion for HIV infection in young patients with PUK and/or CRVO.

Peripheral Ulcerative Keratitis in Sarcoidosis

To document a case of peripheral ulcerative keratitis (PUK) that progressed to corneal perforation in the setting of recently diagnosed sarcoidosis. Observational case report. A 42-year-old white woman presented with a 2-day history of tearing and decreased vision OD, secondary to PUK with corneal perforation. Slit-lamp evaluation revealed bilateral peripheral corneal thinning with vascularized scarring. History, clinical examination, chart review, peripheral lamellar keratoplasty, serologies, and bronchoscopy with biopsy were performed. After lamellar keratoplasty, visual acuity was 20/400 OD and 20/20 OS. She was treated with oral prednisone and high-dose Cytoxan therapy. One year postperforation, she received a limbus-to-limbus penetrating keratoplasty OD. One year after penetrating keratoplasty, the patient's BCVA OD is 20/40. She has stable scarring OS. Workup has revealed serologic and pathologic evidence of sarcoidosis without evidence of any other seropositive vasculitic disease. This patient represents the first known case report of PUK in sarcoidosis. Oral Cytoxan, steroids, and topical cyclosporine have stabilized the disease process in this patient.