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Peripheral ulcerative keratitis as presenting manifestation of systemic microscopic polyangiitis: a case report

David Díaz-Valle1, Blanca Benito-Pascual1, Rosalía Méndez-Fernández1

  • 1Department of Ophthalmology, Hospital Clinico San Carlos, Madrid, Spain.

Arquivos Brasileiros De Oftalmologia
|September 29, 2021
PubMed

Insights

Microscopic polyangiitis, a rare autoimmune vasculitis, can initially present with eye symptoms like peripheral ulcerative keratitis. Early diagnosis and multidisciplinary treatment are crucial for managing this systemic disease.

Area of Science:

  • Rheumatology
  • Ophthalmology
  • Pathology

Background:

  • Microscopic polyangiitis (MPA) is a rare autoimmune disease causing blood vessel inflammation and necrosis.
  • It is a subset of antineutrophil cytoplasmic antibody-associated vasculitides, affecting multiple organs.
  • Ocular manifestations can be initial presenting symptoms, highlighting the need for a multidisciplinary approach.

Observation:

  • An 82-year-old woman presented with peripheral ulcerative keratitis.
  • This ocular symptom was the first indication of an underlying systemic disease.
  • The presentation necessitated a comprehensive diagnostic workup.

Findings:

  • The patient's peripheral ulcerative keratitis led to the diagnosis of microscopic polyangiitis.
  • This case underscores the potential for ocular symptoms to be the primary presentation of MPA.
  • Early identification of MPA through ocular signs is critical.

Implications:

  • Prompt diagnosis of MPA, even when presenting with ocular symptoms, is vital for effective treatment.
  • A multidisciplinary approach involving ophthalmology and rheumatology is essential for managing MPA.
  • Aggressive treatment, potentially including surgery, can limit damage and preserve visual function in MPA patients.

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