Corneal ulcer in reactive arthritis.

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Reactive arthritis is a spondyloarthropathy characterized by oligoarthritis, enthesitis, and ocular inflammation.
• Human leukocyte antigen-B27 (HLA-B27) positivity is common in reactive arthritis.
• Ocular manifestations can range from conjunctivitis to severe uveitis and keratitis.

Observation:

• A 20-year-old male presented with symptoms of reactive arthritis, including lower limb oligoarthritis and enthesitis, preceded by a diarrheal illness.
• He developed acute anterior uveitis with a paracentral corneal ulcer and stromal infiltrates in the right eye.
• Microbiological analysis identified Staphylococcus hominis, but the clinical course suggested an immune-mediated component.

Findings:

• Initial treatment with topical antibiotics for the corneal ulcer led to epithelial healing but persistent stromal infiltrates.
• Subsequent treatment with topical steroids resolved the residual keratitis and stromal haze.
• The patient's visual acuity improved from 20/120 to 20/20 after steroid treatment.

Implications:

• This case underscores the importance of considering immune-mediated keratitis in the context of reactive arthritis, even with a positive microbial culture.
• Prompt recognition and appropriate management, including the judicious use of corticosteroids, are crucial for favorable visual outcomes.
• The interplay between infection, systemic inflammation, and ocular pathology in reactive arthritis warrants further investigation.