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Rituximab treatment for corneal perforation with peripheral ulcerative keratitis associated to Wegener's granulomatosis

Poster Details

First Author: A.Lanuza Garcia SPAIN

Co Author(s):    L. Perez-Varona   M. Alvarez Diaz   J. Castellano        

Abstract Details

Purpose:

There are several systemic diseases such as rheumatoid arthritis (RA) and Wegener's granulomatosis (WG) who may develop a severe form of peripheral ulcerative keratitis (PUK) that can progress to corneal perforation. We report a case of a woman who suffered from RA and WG. She had further bilateral PUK in the right with a quick evolution, undergoing two corneal perforations in the same eye . With systemic and topical treatment PUK is not reduced, and given the risk of a third corneal perforation, for this reason it was decided to treat it with antibodies, which stopped the corneal process.

Setting:

A case report

Methods:

A 65-year-old female with RA, WG. Its systemic vasculitis with cyclophosphamide were treated for 7-years suffering a toxic myelosuppression secondary to this drug, since it is treated with corticosteroids 9mgr-day. She was to the emergency due to red right eye, pain and photophobia, showed inferior temporal corneal ulceration. Despite treatment, a corneal perforation is observed with keeping camera, it proceeds to repair the perforation with cyanoacrylate adhesive, membrane amniotic and high-dose systemic corticosteroids. The evolution is favorable. She comes two months with pain in the right eye, appreciating a new corneal perforation. It proceeds to seal the cornea with cyanoacrylate.

Results:

Given the risk of a new perforation and in order not to maintain high doses of corticosteroids for a long time, we decided to treat it with 1g Rituximab in two doses within two weeks. With this treatment the progression of PUK stopped and the dose of systemic corticosteroids was reduced its initial level. She received 4 doses over three years and this stationary keratitis

Conclusions:

Rituximab is a humanised monoclonal antibody against the CD20 antigen that is expressed on the cell surface during early pre-B cell development and persists through all stages of B cell differentiation. It results in rapid depletion of CD20 positive B lymphocytes from the circulating blood and is well tolerated. It has reported several cases of improvement of treating PUK with Rituximab in patients with Wegener and rheumatoid arthritis. Our patient has both diseases, since the supplied this antibody has not presented any aggravation of the corneal process. When PUK is not resolved with autoimmune treatment, you may consider using antibodies FINANCIAL DISCLOUSRE: NONE

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