Bilateral punctate keratitis and hurricane keratopathy following apremilast therapy

To report a unique case of bilateral punctate keratitis consistent with hurricane keratopathy during apremilast therapy.

A 49-year-old female presented with severe, painful, bilateral, punctate keratitis following five months of apremilast therapy. The past ocular history was noncontributory. The past medical history included psoriasis refractory to topical corticosteroids. The patient subsequently received systemic apremilast therapy and noted improvement in her psoriatic rash. Five months later the patient presented to an outside eye care provider complaining of three weeks of progressive photophobia associated with pain and redness in both eyes. On examination, the patient had decreased visual acuity with diffuse conjunctival injection and punctate epithelial erosions in a whorl-like pattern in both eyes. The remainder of the ophthalmic exam was unremarkable. The patient was started on topical moxifloxacin drops, erythromycin ointment, and preservative free artificial tears, but did not improve. Apremilast was then discontinued and topical prednisolone was added once per day. Ten weeks after discontinuation of apremilast and topical steroid therapy, the patient had recovered normal vision with an intact and normal corneal epithelium.

This is the first case report of cornea epithelial keratitis resembling hurricane keratopathy associated with apremilast treatment and should be recognized as a possible side effect of therapy with this class of drug.