[Peripheral ulcerative keratitis with necrotizing scleritis, manifestation of granulomatosis with polyangiitis].

Alejandro Ulises Rebolloso-González, Dolores de Los Ángeles González-De la Mora
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Abstract

Background: Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated autoimmune disorder that typically affects small and/or medium size vessels. A collaborative management form ophthalmologist and rheumatologist could led to long term remission of the disease despite being yet a life threatening pathology.

Clinic case: A 61 years old masculine complied of recurrent cases of ocular discomfort managed as a bacterial conjunctivitis for 2 years, also patient with loss of visual acuity and weight loss mainly in the three previous months. After discard infectious diseases such as tuberculosis and syphilis being in a high incidence country GPA investigation were carried out and later diagnosed. He was to start proper treatment with rituximab but as systemic complications advance he could not managed to achieve disease control. Ocular involvement has been show to occur in around 30% percent of cases in several studies. It could cause scleritis as well as conjuntivitis, episcleritis, necrotizing keratitis, corneoscleral perforation, posterior uveitis, and optic neuritis. C-ANCA and high positive PR3 autoantibody have strong association and sensitivity with GPA. Rituximab has been prove to be the most accurate treatment for this disease.

Conclusions: Necrotizing scleritis and peripheral ulcerative keratitis can be manifestation of GPA. An ophthalmic check up may be the key to reach a promptly diagnosis of a tough systemic case.

[周围性溃疡性角膜炎伴坏死性巩膜炎,肉芽肿病伴多血管炎的表现]。
背景:肉芽肿病合并多血管炎(GPA)是一种与抗中性粒细胞细胞质抗体(ANCA)相关的自身免疫性疾病,通常影响小血管和/或中型血管。眼科医生和风湿病学家的合作管理可以导致疾病的长期缓解,尽管这是一种危及生命的病理。临床病例:男性,61岁,复发性眼部不适,以细菌性结膜炎治疗2年,视力下降,体重下降主要发生在前3个月。在丢弃了结核病和梅毒等高发国家的传染病后,进行了GPA调查并进行了诊断。他开始使用美罗华进行适当的治疗,但随着全身并发症的进展,他无法控制疾病。几项研究表明,眼部受累发生率约为30%。它可以引起巩膜炎、结膜炎、外膜炎、坏死性角膜炎、角膜巩膜穿孔、后葡萄膜炎和视神经炎。C-ANCA和高阳性PR3自身抗体与GPA有较强的相关性和敏感性。利妥昔单抗已被证明是治疗这种疾病最准确的方法。结论:坏死性巩膜炎和周围性溃疡性角膜炎可能是GPA的表现。眼科检查可能是达到一个棘手的系统性病例及时诊断的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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