Ocular immunology and inflammation · 2025
Juvenile Idiopathic Arthritis-Associated Peripheral Ulcerative Keratitis and Anterior Uveitis in a Pediatric Patient with Trisomy 21.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sandozi Heba, Moon Jade Y, Ketkar Sachin, Sattarova Victoria, Armbrust Karen R, Chanbour Wassef
Аннотация
PURPOSE: Peripheral ulcerative keratitis (PUK) is a rare, vision-threatening disorder that typically occurs in adults with underlying autoimmune disease or infection. Few cases of pediatric PUK have been reported, making clinical guidelines rare.
METHODS: Case report.
RESULTS: A 13-year-old female with Trisomy 21 and well-controlled Graves' Disease and no history of ocular trauma presented with ten days of right eye pain refractory to treatment with topical antibiotics and corticosteroids. Visual acuity was count fingers and slit lamp examination showed marked conjunctival injection, as well as a fibrin band in the anterior chamber. Corneal examination demonstrated substantial inferior peripheral stromal thinning and overlying epithelial defect concerning for PUK, prompting hospital admission for management and systemic disease workup. Effusive asymmetric arthritis of the left lower ankle, left knee, and left hand was suspicious for juvenile idiopathic arthritis (JIA) and laboratory studies showed elevated CRP and ESR levels. Despite medical treatment with IV methylprednisolone 1000 mg daily and fortified antibiotic eye drops four times per day, a corneal descemetocele formed, prompting urgent surgical intervention. The patient underwent two interventions with amniotic membrane transplantation. Four months after initial presentation, visual acuity in the affected eye had improved to 20/25, same as fellow eye, and slit lamp examination showed corneal re-epithelialization, healed descemetocele, and ocular inflammatory control on methotrexate monotherapy. The final ocular diagnosis was PUK and anterior uveitis secondary to JIA.
CONCLUSION: Based on our clinical course, we recommend early systemic treatment to manage rapidly progressive corneal thinning in pediatric PUK. Early surgical intervention can be considered to avoid perforation.
METHODS: Case report.
RESULTS: A 13-year-old female with Trisomy 21 and well-controlled Graves' Disease and no history of ocular trauma presented with ten days of right eye pain refractory to treatment with topical antibiotics and corticosteroids. Visual acuity was count fingers and slit lamp examination showed marked conjunctival injection, as well as a fibrin band in the anterior chamber. Corneal examination demonstrated substantial inferior peripheral stromal thinning and overlying epithelial defect concerning for PUK, prompting hospital admission for management and systemic disease workup. Effusive asymmetric arthritis of the left lower ankle, left knee, and left hand was suspicious for juvenile idiopathic arthritis (JIA) and laboratory studies showed elevated CRP and ESR levels. Despite medical treatment with IV methylprednisolone 1000 mg daily and fortified antibiotic eye drops four times per day, a corneal descemetocele formed, prompting urgent surgical intervention. The patient underwent two interventions with amniotic membrane transplantation. Four months after initial presentation, visual acuity in the affected eye had improved to 20/25, same as fellow eye, and slit lamp examination showed corneal re-epithelialization, healed descemetocele, and ocular inflammatory control on methotrexate monotherapy. The final ocular diagnosis was PUK and anterior uveitis secondary to JIA.
CONCLUSION: Based on our clinical course, we recommend early systemic treatment to manage rapidly progressive corneal thinning in pediatric PUK. Early surgical intervention can be considered to avoid perforation.