UNILATERAL OCULAR CICATRICIAL PEMPHIGOID SECONDARY TO LEVAMISOL-ADULTERED COCAINE CONSUMPTION

Published 2022 - 26th ESCRS Winter Meeting

Reference: CR21 | Type: Cornea Day Case Presentations | DOI: 10.82333/j4yz-gc10

Authors: June Artaechevarria Artieda* ¹ , Marta Fernandez Gurria ¹ , Jose Javier San Roman Llorens ² , Blanca Garcia Sandoval ² , Nicolas Alejandre Alba ¹

¹Ophthalmology,HOSP. UNIVERSITARIO FUNDACION JIMENEZ DIAZ,Madrid,Spain, ²Ophthalmology,HOSP. UNIVERSITARIO FUNDACION JIMENEZ DIAZ,Madrid,Spain;Ophthalmology,Ruber Juan Bravo Hospital,Madrid,Spain

To describe the clinical findings and management of a unilateral ocular cicatricial pemphigoid (OCP) secondary to Levamisol-adultered cocaine consumption.

Referral hospital Fundación Jiménez Díaz

A 48-year-old woman consulted for left eye (LE) vision loss and oral ulcers for the last 6 months. She referred inhaled cocaine consumption through her left nasal fossae. On examination, best corrected visual acuity (BCVA) was 1.0 logMAR in her right eye (RE) and hand movement in LE. The slit-lamp biomicroscopy showed a complete corneal conjunctivalization, shortening of the fornices, temporal symblepharon, cicatricial entropion of the superior eyelid eyelashes with the cornea causing a temporal epithelial defect. Anterior chamber was preserved. On sytemic examination, a well delimited diffuse lingual ulcer that respected the base and the tip of the tongue was found. No other dermatological lesions were observed. A complete blood analysis was performed to rule out infectious or autoinmune diseases. The conjunctival biopsy showed intersticial linfocite inflammation and was negative for direct immunofluorescence (DIF). The oral biopsy showed acute and chronic inflamation and DIF yielded a linear IgA deposit along the epithelium basal membrane. The indirect immunofluorescence (IIF) detected high circulating IgA levels.

OCP is a chronic cicatricial disease affecting mucous membranes and skin, which can lead to ankyloblepharon in severe cases. It is an autoimmune response caused by an environmental trigger which leads to inflammation and scarring, in this case the levamisol-adultered cocaine. DIF of conjunctival or oral mucous biopsy is the gold standard to confirm the diagnosis, showing a linear deposition of IgG, IgA, IgM and complement 3 proteins in the epithelial basement membrane. A multidisciplinar management is essential to control the inflammation and halt the progression. Topical treatments alleviate symptoms but only systemic immunosupression stops progression. Surgical interventions can be employed as adjunctive therapy to treat complications.