Disseminated keratoconjunctival epitheliopathy in a patient with systemic lupus erythematosus

摘要

Conjunctivocorneal involvement in systemic lupus erythematosus (SLE) is quite infrequent. We report the impression cytological (IC), immunohistochemical (IHC), and transmission electron microscopic (TEM) features of a case with unusual keratoconjunctival epitheliopathy refractory to medical treatment. A 76 year old woman was referred with a long history of bilateral foreign body sensation. She had been on topical antibiotics, artificial tears, corticosteroids, hyaluronate, and aciclovir without improvement. At initial examination, biomicroscopy revealed diffuse, translucent, disseminated peripheral corneal intraepithelial coin lesions with a cystic appearance (fig 1A, B), also in the bulbar conjunctiva over the limbus (fig 1C). Fluorescein staining revealed increased permeability with negative staining. Schirmer's test was normal in both eyes. The patient had systemic and dermatological features diagnosed as SLE and had been taking predniso-lone 7.5 mg/day for 1 year. Conjunctival cultures were negative for infectious processes. A thorough systemic evaluation for other systemic diseases and serum antibodies for herpes simplex virus (HSV-I, HSV-2), varicella zoster virus (VZV), and Epstein-Barr virus (EBV) were negative.