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A Case of Bilateral Peripheral Ulcerative Keratitis

Received: 31 May 2021     Accepted: 15 June 2021     Published: 30 June 2021
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Abstract

Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It may precede the diagnosis of the systemic condition and therefore these cases require urgent investigation. A 43-year-old woman presented with bilateral tearing and ocular pain persisting for 7 months. Visual acuity was 6/6 in both eyes. On biomicroscopic examination, presence of crescent shaped corneal ulcer with perilesional haziness. A tear film study demonstrated decreased Schirmer test results (5mm in both eyes) and tear film break-up time (5 sec in both eyes). The interrogation and the patient revealed he had recurrent skin lesions in both legs with chronic itching, and recurrent oral and genital ulcers healing spontaneously. The diagnosis of Behcet disease was proposed. Pathergy test was negative, HLA B51 was positif. Systemic therapy was started with colchicine at a dose of 2mg/day. Eye drops and systemic prednisolone at 1mg/kg/day was continued with progressive decrease. The follow up at 3 months and 6 months showed no signs of recurrence of ulceration in both eyes. Corneal manifestation has rarely been reported in Behçet’s disease. Combined intraocular anterior and posterior segment inflammation are most common features of ocular Behçet disease. Collaborative management of ophthalmic patients having systemic illness along with internists improves overall outcomes and prevents morbidity in such patients.

Published in International Journal of Ophthalmology & Visual Science (Volume 6, Issue 2)
DOI 10.11648/j.ijovs.20210602.23
Page(s) 150-153
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Ocular Inflammation, Corneal Ulcer, Amniotic Membrane, Behcet Disease, PUK

References
[1] Tavassoli S, Gunn D, Tole D, Darcy K. Peripheral ulcerative keratitis with corneal melt as the primary presentation in a case of human immunodeficiency virus. BMJ Case Rep. 2019 Feb 22; 12 (2). doi: 10.1136/bcr-2018-226936.
[2] Ploysangam P, Marie R. Perforating Peripheral Ulcerative Keratitis in Syphilis. Case Rep Ophthalmol. 2019 Aug 13; 10 (2): 267-273. doi: 10.1159/000501996.
[3] Lee WS, Choi YJ, Yoo WH. Rapid Progressive Peripheral Ulcerative Keratitis Associated with Longstanding Rheumatoid Arthritis. J Rheumatol. 2016 Oct; 43 (10): 1909-1910. doi: 10.3899/jrheum.160262
[4] Akdeniz N, Elmas ÖF, Karadağ AS. Behçet’s Syndrome: A great imitator. Clin Dermatol. 2019 May - Jun; 37 (3): 227-239. doi: 10.1016/j.clindermatol.2019.01.001.
[5] Hamuryudan V, Er T, Seyahi E, Akman C, Tüzün H, Fresko I, Yurdakul S, Numan F, Yazici H. Pulmonary artery aneurysms in Behçet syndrome. Am J Med. 2004 Dec 1; 117 (11): 867-70. doi: 10.1016/j.amjmed.2004.05.027.
[6] Hatemi G, Christensen R, Bang D, et al. Recommendations for the management of Behcet’s syndrome. Ann Rheum Dis. 2018 Jun; 77 (6): 808-818. doi: 10.1136/annrheumdis-2018-213225.
[7] Kitaichi N, Miyazaki A, Iwata D, Ohno S, Stanford MR, Chams H. Ocular features of Behcet’s disease: an international collaborative study. Br J Ophthalmol. 2007 Dec; 91 (12): 1579-82. doi: 10.1136/bjo.2007.123554.
[8] Rohtagi J, Singal A. Ocular manifestations of Behcet’s disease in indian patients. Indian J Ophthalmol. 2003 Dec; 51 (4): 309-13.
[9] Yong-Sok Ji, Kyung Chul Yoon. A rare case of peripheralulcerative keratitis associated with Behcet’s disease. Int ophthalmol. 2014 Aug; 34 (4): 979-81.
[10] Dorot N, Coulon L, Poirier L, Brousse D, Mortemousque B, Verin P. Corneal ulcer and Behcet disease. J Fr Ophthalmol. 1995; 18 (2): 155-7.
[11] Zeng J, Chen B. Severe primary ocular surface involvement in Behcet disease. Optom Vis Sci. 2014 Dec; 91 (12): e301-4. doi: 10.1097/OPX.0000000000000405.
[12] Jinagal J, Agarwal A, Negi A, Gupta G, Sharma V, Gupta PC, Ram J. Immune keratitis: An unusual primary presentation of neuro-Behçet’s disease. Eur J Ophthalmol. 2019 Jul; 29 (4): NP5-NP8. doi: 10.1177/1120672118803534.
Cite This Article
  • APA Style

    Belghmaidi Sarah, Darfaoui Zineb, Hajji Ibtissam, Moutaouakil Abdeljalil. (2021). A Case of Bilateral Peripheral Ulcerative Keratitis. International Journal of Ophthalmology & Visual Science, 6(2), 150-153. https://doi.org/10.11648/j.ijovs.20210602.23

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    ACS Style

    Belghmaidi Sarah; Darfaoui Zineb; Hajji Ibtissam; Moutaouakil Abdeljalil. A Case of Bilateral Peripheral Ulcerative Keratitis. Int. J. Ophthalmol. Vis. Sci. 2021, 6(2), 150-153. doi: 10.11648/j.ijovs.20210602.23

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    AMA Style

    Belghmaidi Sarah, Darfaoui Zineb, Hajji Ibtissam, Moutaouakil Abdeljalil. A Case of Bilateral Peripheral Ulcerative Keratitis. Int J Ophthalmol Vis Sci. 2021;6(2):150-153. doi: 10.11648/j.ijovs.20210602.23

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  • @article{10.11648/j.ijovs.20210602.23,
      author = {Belghmaidi Sarah and Darfaoui Zineb and Hajji Ibtissam and Moutaouakil Abdeljalil},
      title = {A Case of Bilateral Peripheral Ulcerative Keratitis},
      journal = {International Journal of Ophthalmology & Visual Science},
      volume = {6},
      number = {2},
      pages = {150-153},
      doi = {10.11648/j.ijovs.20210602.23},
      url = {https://doi.org/10.11648/j.ijovs.20210602.23},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20210602.23},
      abstract = {Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It may precede the diagnosis of the systemic condition and therefore these cases require urgent investigation. A 43-year-old woman presented with bilateral tearing and ocular pain persisting for 7 months. Visual acuity was 6/6 in both eyes. On biomicroscopic examination, presence of crescent shaped corneal ulcer with perilesional haziness. A tear film study demonstrated decreased Schirmer test results (5mm in both eyes) and tear film break-up time (5 sec in both eyes). The interrogation and the patient revealed he had recurrent skin lesions in both legs with chronic itching, and recurrent oral and genital ulcers healing spontaneously. The diagnosis of Behcet disease was proposed. Pathergy test was negative, HLA B51 was positif. Systemic therapy was started with colchicine at a dose of 2mg/day. Eye drops and systemic prednisolone at 1mg/kg/day was continued with progressive decrease. The follow up at 3 months and 6 months showed no signs of recurrence of ulceration in both eyes. Corneal manifestation has rarely been reported in Behçet’s disease. Combined intraocular anterior and posterior segment inflammation are most common features of ocular Behçet disease. Collaborative management of ophthalmic patients having systemic illness along with internists improves overall outcomes and prevents morbidity in such patients.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - A Case of Bilateral Peripheral Ulcerative Keratitis
    AU  - Belghmaidi Sarah
    AU  - Darfaoui Zineb
    AU  - Hajji Ibtissam
    AU  - Moutaouakil Abdeljalil
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    DO  - 10.11648/j.ijovs.20210602.23
    T2  - International Journal of Ophthalmology & Visual Science
    JF  - International Journal of Ophthalmology & Visual Science
    JO  - International Journal of Ophthalmology & Visual Science
    SP  - 150
    EP  - 153
    PB  - Science Publishing Group
    SN  - 2637-3858
    UR  - https://doi.org/10.11648/j.ijovs.20210602.23
    AB  - Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It may precede the diagnosis of the systemic condition and therefore these cases require urgent investigation. A 43-year-old woman presented with bilateral tearing and ocular pain persisting for 7 months. Visual acuity was 6/6 in both eyes. On biomicroscopic examination, presence of crescent shaped corneal ulcer with perilesional haziness. A tear film study demonstrated decreased Schirmer test results (5mm in both eyes) and tear film break-up time (5 sec in both eyes). The interrogation and the patient revealed he had recurrent skin lesions in both legs with chronic itching, and recurrent oral and genital ulcers healing spontaneously. The diagnosis of Behcet disease was proposed. Pathergy test was negative, HLA B51 was positif. Systemic therapy was started with colchicine at a dose of 2mg/day. Eye drops and systemic prednisolone at 1mg/kg/day was continued with progressive decrease. The follow up at 3 months and 6 months showed no signs of recurrence of ulceration in both eyes. Corneal manifestation has rarely been reported in Behçet’s disease. Combined intraocular anterior and posterior segment inflammation are most common features of ocular Behçet disease. Collaborative management of ophthalmic patients having systemic illness along with internists improves overall outcomes and prevents morbidity in such patients.
    VL  - 6
    IS  - 2
    ER  - 

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Author Information
  • Ophtalmology Department, Mohammed VI University Hospital, Marrakech, Morocco

  • Ophtalmology Department, Mohammed VI University Hospital, Marrakech, Morocco

  • Ophtalmology Department, Mohammed VI University Hospital, Marrakech, Morocco

  • Ophtalmology Department, Mohammed VI University Hospital, Marrakech, Morocco

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