Development of Superficial Thrombophlebitis and Subsequent Central Retinal Vein Occlusion Occurring in a Patient Receiving IVIg for Ocular Pemphigoid.

PURPOSE: To describe a case of ocular mucous membrane pemphigoid (oMMP) complicated by recurrent superficial thrombophlebitis (STP) and central retinal vein occlusion (CRVO) during intravenous immunoglobulin (IVIg) therapy.

METHODS

Observational case report.

RESULTS

A 43-year-old male developed STP in the left dorsal hand and forearm following the first and third months of IVIg therapy. Despite conservative management, the patient presented with acute right-eye vision loss after the fifth infusion cycle, and fundus examination confirmed non-ischemic CRVO. Laboratory workup revealed elevated anti-cardiolipin IgM antibodies, indicating a prothrombotic state. IVIg was discontinued and replaced with systemic anticoagulation and rituximab. An intravitreal injection for macular edema led to partial recovery of visual acuity (20/25) following subsequent cataract extraction, though a residual paracentral scotoma persisted.

CONCLUSION

IVIg can effectively control severe oMMP but may increase the risk of thromboembolic events in predisposed individuals. Recurrent STP during IVIg therapy may serve as an early indicator of a more serious vascular complication, such as CRVO. Recognizing and investigating hypercoagulability in these patients is critical for preventing irreversible vision loss and guiding safer therapeutic strategies.