Crystallin-Like Keratopathy After Intravenous Immunoglobulin Treatment In A Patient With Acute Myasthenia Gravis

The myasthenic crisis is a severe generalized quadriparesis or life-threatening respiratory muscle weakness that can be managed with intravenous immunoglobulin. This can induce a crystalline-like keratopathy.

Ophtalmology B departmet at IBN SINA universitary hospital , Rabat , Morocco

this is a 45 year old man, followed for myasthenia gravis, receiving an intravenous immunoglobulin treatment, presenting 7 days after the treatment a decrease in visual acuity of 3/10th in ODG with photophobia. the slit lamp examination shows bilateral diffuse crystalline deposits in the corneal epithelium. the rest of the examination is without particularities. The keratopathy cristallin-like was taken into consideration given the clinical context and the absence of other ophthalmological history. a treatment with corticoids eye drops associated with artificial tears was started. a clear improvement was noted during a control carried out one week later and the acuity returned to 10/10th in ODG.Despite the fact that the pathogenesis of acute and steroid-sensitive crystalline keratopathy is not elucidated, corneal diffusion of subconjunctival injected human immunoglobulin has been demonstrated in experimental studies.

the appearance of photophobia with a decrease in visual acuity in a patient receiving intravenous immunoglobulin should lead to the detection of possible corneal deposits of Immunoglobulin that may impair visual function.