[Peripheral ulcerative keratitis in a 24-year-old patient]

A 24-year-old female patient was admitted to hospital with a deep stromal corneal defect on the right eye and a melting marginal keratitis on the left eye with a differential diagnosis of Mooren's ulcer. Despite intensive topical and systemic therapy, the ulcer perforated 3 days later and perforating keratoplasty à chaud was performed. The histological examination of the cornea showed a mainly intact corneal structure with a sharp demarcation line between the melting process close to the limbus and the unaffected tissue. The limbal area was interspersed with inflammatory cells. During the subsequent clinical course, despite intensive immunosuppressive therapy with Cellcept, systemic and local cyclosporin and methotrexate the left eye perforated and was subsequently treated by perforating keratoplasty. Under immunosuppression with methotrexate and local steroids no recurrence or progression has occurred so far.