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Published on: August 9, 2016
Ligneous conjunctivitis mimicking preseptal cellulitis in a 3-month-old infant
Valentien Merlevede1, Virginie Ninclaus1,2, Dimitri Roels1,2
1Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.
Insights
Ligneous conjunctivitis, a rare condition, can mimic preseptal cellulitis in infants. Topical heparin eye drops effectively treated a case in an infant, offering a promising first-line therapy.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
Background:
- Ligneous conjunctivitis is an exceptionally rare form of pseudomembranous conjunctivitis.
- This condition often presents with symptoms that can be mistaken for more common infections like preseptal cellulitis.
Observation:
- A 3-month-old infant presented with progressive eyelid edema unresponsive to antibiotics.
- Examination revealed wood-like, fibrinous pseudomembranes characteristic of ligneous conjunctivitis.
- Low plasminogen activity was noted, though no pathogenic variant in the PLG gene was identified.
Findings:
- Histopathology confirmed fibrin as the primary component of the pseudomembranes.
- The infant's corneal epithelium healed, and conjunctival lesions resolved with heparin-containing artificial tears.
- This treatment demonstrated efficacy in a pediatric case of ligneous conjunctivitis.
Implications:
- A high index of suspicion for ligneous conjunctivitis is crucial in infants with atypical preseptal cellulitis.
- General anesthesia aids diagnosis in young children with unusual eyelid swelling.
- Topical heparin eye drops represent an effective and accessible initial treatment for ligneous conjunctivitis, especially in milder forms.
Background:
Ligneous conjunctivitis is a very rare form of pseudomembranous conjunctivitis with few published cases in literature. We aim to describe the ocular findings and treatment in an infant with ligneous conjunctivitis resembling preseptal cellulitis on presentation.
Materials And Methods:
Case report of a 3-month-old girl who was referred to a tertiary centre for ophthalmic assessment due to progressive eyelid oedema with no response to initiated topical and systemic antibiotics. Ethical approval has been achieved from the local ethics committee of the Ghent University Hospital and informed consent has been obtained from the parents of the child.
Results:
Examination under general anaesthesia showed multiple, wood-like fibrinous pseudomembranes, originating from the conjunctiva, consistent with ligneous conjunctivitis. After careful removal of the coagulated exudate covering the cornea, a central corneal epithelial defect was evident without stromal infiltration. Histopathologic examination confirmed the predominance of fibrin within the pseudomembranes. Plasminogen activity was below the normal range. Genetic analysis did not identify a pathogenic variant in the PLG gene. The corneal epithelium re-epithelialised during the following days and the conjunctival lesions gradually subsided over the ensuing weeks whilst continuing heparin-containing artificial tears.
Conclusion:
A high level of suspicion is warranted in atypical cases of preseptal cellulitis which show no response to antibiotic treatment. Particularly in young children, examination under general anesthesia is warranted to allow diagnosis of rare causes of secondary eyelid oedema. We report an infant with unilateral ligneous conjunctivitis who responded well to topical, commercially-available heparin-containing artificial tears treatment. This approach is an effective and easy first-line treatment option in this condition, particularly in milder phenotypes.
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