Peripheral Ulcerative Keratitis In The Setting Of Acute Leukaemia And Rheumatoid Arthritis, A Case Report

• To document a case of peripheral ulcerative keratatis (PUK)  in a leukaemic patient with a history of rheumatoid arthritis, the leading cause of PUK

• Peripheral ulcerative keratitis  (PUK) is a progressive superficial erosion which begins as a narrow crescentic corneal infiltrate just inside the limbus and spreads both circumferentially  and centrally. It represents often an ocular manifestation of an underlying systemic condition. Leukaemia is a rare etiology, and very few cases have been reported in theory
• We report the iconography of a patient who presented to the emergency department for a PUK in the context of acute monoblastic leukaemia

A 47-year-old patient  with a medical history of rheumatoid arthritis , and more recently  leukaemia  (M5a), treated with chemotherapy , currently in aplastic anemia presented to  the ophthalmology emergency department with complaints of pain, redness in the right eye since  7 days 

 Examination:

• Right eye: best corrected visual acuity 6/10, conjunctival hyperaemia, circumferential whitish corneal serpiginous infiltrate , extending over almost 360 degrees. the rest of the anterior segment was normal
• Left eye and posterior segmental examination of both eyes were unremarkablecorneal swabs were sent for microscopy and culture
• the patient died one week after his consultation

• Autoimmune diseases are known to pave the way for tumor pathologies. Our patient had two etiologies: rheumatoid arthritis, which is the most frequent cause of PUK , and leukemia, more rarely described .
• In this case, the rapid progression of the ulcer : 360 degrees within one week suggests that acute leukaemia contributed to the development of PUK either by  deposition of leukaemic blast cells around the limbus and peripheral cornea or by  paraneoplastic mechanism
• By corneal and conjunctival biopsy , Histological features allows to highlight neoplastic infiltration and rule out   infectious cause, ,especially that bone marrow aplasia promotes the superinfection

• PUK requires a very meticulous diagnostic approach that would allow it to be linked to an etiology that may be previously unknown
• Our case aligns with data from the literature, confirming the very poor prognosis of leukemias when they involve the eye.