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Phlyctenular keratoconjunctivitis - an atypically severe case treated with systemic biologic immunosuppressive
Joana Valério Sequeira Valadares1, Ana Bastos-Carvalho1, José Manuel Pedroso Franco1
1Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisbon, Portugal.
GMS Ophthalmology Cases
|September 15, 2016
Summary
Severe phlyctenular keratoconjunctivitis (PKC) in a child responded well to biologic therapy. Systemic infliximab and methotrexate successfully treated this refractory case, offering a new treatment avenue.
Area of Science:
- Ophthalmology
- Immunology
Background:
- Phlyctenular keratoconjunctivitis (PKC) can present with varied severity.
- Refractory cases pose significant treatment challenges.
Observation:
- A 10-year-old female presented with severe, bilateral PKC refractory to conventional therapies including corticosteroids, cyclosporine A, and methotrexate.
- Corneal neovascularization, peripheral thinning, and anterior chamber reactions were noted.
Findings:
- Combination therapy with infliximab and methotrexate led to rapid and sustained resolution of PKC symptoms and corneal signs.
- The patient remained asymptomatic with no disease recurrence at 11-month follow-up.
Implications:
- Systemic biologic immunosuppressive therapy, specifically infliximab combined with methotrexate, is a viable alternative for severe, refractory PKC.
- This approach may prevent vision-threatening complications associated with severe ocular surface inflammation.
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