CORNEAL PERFORATION ASSOCIATED WITH PYODERMA VEGETANS REPAIRED WITH TECTONIC KERATOPLASTY: A CASE REPORT

The aim of the case report was to highlight a rare case of corneal perforation linked to pyoderma vegetans, emphasizing the importance of interdisciplinary management for effective treatment.

A 62-year-old male with chronic scalp and neck lesions without any systemic diseases developed spontaneous corneal melting and perforation in the right eye. He underwent multilayer amniotic membrane grafting, followed by tectonic corneal transplantation due to shallow anterior chamber and ongoing risk of perforation. Dermatology evaluation included scalp and neck biopsies showing ulcerative neutrophilic dermatosis compatible with pyoderma vegetans, a rare neutrophilic dermatosis and subtype of pyoderma gangrenosum. Evaluation revealed no systemic autoimmune disease. Negative results for ANA, MPO-/PR3-ANCA, and normal complement levels excluded systemic conditions like rheumatoid arthritis or vasculitis.

Tectonic corneal graft restored globe integrity, and the anterior chamber was stabilized. A best Snellen acuity of 0.63 was achieved within a month following the surgery. Dermatologic treatment resulted in partial improvement of scalp lesions. No systemic autoimmune condition was identified. The ocular and dermatologic findings were considered localized manifestations of neutrophilic dermatosis.

Pyoderma vegetans can rarely involve the cornea, leading to sterile corneal melting and perforation. Successful management requires early recognition and close interdisciplinary collaboration, combining surgical ophthalmologic intervention with dermatologic and rheumatologic evaluation. Awareness of such associations is essential to prevent vision-threatening complications.