Ocular Mucous Membrane Pemphigoid: Immunomodulation in a Patient with Human Immunodeficiency Virus Infection.

Purpose: To report the clinical course and management of a case of ocular mucous membrane pemphigoid (oMMP) in a patient with human immunodeficiency virus (HIV) infection.

Methods: A 58-year-old gentleman presented with ocular pain, photophobia, and redness in both eyes for 2 years. He had aqueous deficient dry eye disease and was advised investigations to rule out underlying connective tissue disorders. The patient had HIV infection and was on oral anti-retroviral therapy for this condition. He was subsequently lost to follow-up and presented after 4 years with a visual acuity of counting fingers in both eyes. There was a shortening of the inferior fornices with subconjunctival fibrosis and total cataract in both eyes. A conjunctival biopsy was performed to establish the diagnosis.

Results: The conjunctival biopsy revealed the presence of oMMP. After ascertaining that the systemic parameters were normal and with a CD4 count of 524 cells/mm³, the patient was started on oral methotrexate. These tests were monitored every 3 months and no adverse effects were noted. The CD4 counts were stable at the last follow-up, 1 year after the diagnosis of oMMP. There was no progression of cicatrization and the visual acuity improved with cataract surgery and scleral contact lenses to 20/50 and 20/40 in the right and left eye, respectively.

Conclusion: Systemic immunosuppression is essential in patients with oMMP to prevent disease progression. It can be safely instituted in patients with HIV infection via a multi-disciplinary approach with stringent monitoring of systemic parameters and CD4 counts.