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Discoid lupus erythematosus and cicatrizing conjunctivitis: clinicopathologic study of two cases
Jennifer E Thorne1, Douglas A Jabs, Olga Nikolskaia
1Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. jthorne@jhmi.edu
Background:
Discoid lupus erythematosus (DLE) demonstrates both cutaneous and mucosal manifestations. Mucosal involvement is typically limited to the oral and anogenital mucosa. Conjunctival involvement in DLE is rare, especially in the absence of accompanying cutaneous disease.
Objective:
We describe the clinical and immunopathologic features of two cases of cicatrizing conjunctivitis due to DLE.
Methods:
In each patient, the clinical, immunopathologic, and serologic features were reviewed and the results recorded.
Results:
Both patients presented with cicatrizing conjunctivitis suggestive of mucous membrane pemphigoid. Patient 1 had no history of typical DLE skin lesions. Patient 2 had a history of cutaneous and oral DLE prior to presentation. Histologic, electron microscopic, and direct immunofluorescence examination confirmed the diagnosis DLE in both patients.
Conclusion:
In patients presenting with cicatrizing conjunctivitis, DLE should be considered in the differential diagnosis. Performing appropriate investigations to distinguish conjunctival DLE from other autoimmune diseases with conjunctival involvement such as mucous membrane pemphigoid is critical in selecting an appropriate treatment regimen, in offering an accurate prognosis, and in monitoring for signs and symptoms of disease progression.