Unique circumferential peripheral keratitis in relapsing polychondritis: A case report.

Abstract

RATIONALE:

Relapsing polychondritis (RP) is a rare collagen disease characterized by inflammation and destruction of cartilage throughout the body. The paper details the clinical course of a case of RP with unique circumferential peripheral keratitis.

PATIENT CONCERNS:

A 54-year-old Japanese woman was referred to the hospital presenting with auricular and ocular pain.

DIAGNOSES:

Based on the auricle biopsy results and the three presenting symptoms (bilateral auricular chondritis, inflammatory arthritis and ocular inflammation), her condition was diagnosed as RP.

INTERVENTIONS:

The three presenting symptoms gradually improved with prednisolone (PSL), methylprednisolone and cyclophosphamide combination therapy, followed by PSL, methotrexate and infliximab combination therapy. However, one month after the initial visit, despite ongoing treatment, a unique circumferential peripheral keratitis suddenly occurred, in which the corneal infiltration gradually clumped together and shrank at the peripheral area. The eye and ear pain showed exacerbations and remissions on reducing the dosage of steroid drugs. The general condition was improved on altering systemic therapy to PSL, methotrexate and tocilizumab.

OUTCOMES:

Keratitis gradually disappeared within 10 months of the initial visit.

LESSONS:

This is the first report of a case of RP causing unique circumferential peripheral keratitis. This keratitis occurred despite use of focal and systemic steroids and showed improvement with general recovery. This may indicate that stabilization of general condition is important for recovery from keratitis in RP.

• Authors: Naohiro Motozawa, Takahiro Nakamura, Seiji Takagi, Masashi Fujihara, Yasuhiko Hirami, Kazuhiro Ishida, Chie Sotozono, Yasuo Kurimoto
• Journal: Medicine (Medicine (Baltimore)) Vol. 96 Issue 41 Pg. e7951 (Oct 2017) ISSN: 1536-5964 [Electronic] United States
• PMID: 29019876 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Cyclophosphamide
• Prednisolone
• Infliximab
• tocilizumab
• Methotrexate

Topics

• Antibodies, Monoclonal, Humanized (administration & dosage)
• Antirheumatic Agents (administration & dosage)
• Arthritis (etiology, pathology)
• Cyclophosphamide (administration & dosage)
• Diagnostic Techniques, Ophthalmological
• Drug Monitoring (methods)
• Drug Therapy, Combination (methods)
• Ear Cartilage (pathology)
• Female
• Humans
• Infliximab (administration & dosage)
• Keratitis (drug therapy, etiology, pathology, physiopathology)
• Methotrexate (administration & dosage)
• Middle Aged
• Polychondritis, Relapsing (complications, diagnosis, drug therapy, physiopathology)
• Prednisolone (administration & dosage)
• Treatment Outcome