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Keratoscleritis and Choroidal Exudative Detachment in the Setting of Ocular Pyoderma Gangrenosum
Jeffrey Bodeen1, Lulwa El Zein2, Justin J Yamanuha2
1Department of Ophthalmology, University of Missouri School of Medicine, Columbia, Missouri, USA, missouri.edu.
Purpose:
The purpose of this study is to report a rare case of ocular pyoderma gangrenosum (PG) presenting as keratoscleritis with choroidal effusion following cataract surgery and to highlight its clinical recognition and management.
Methods:
A 79-year-old man developed a corneal ulcer 2 days after uncomplicated phacoemulsification with intraocular lens implantation. Initial management with topical vancomycin and ceftazidime failed. Comprehensive systemic workup including TPMT, HLA-B51, ANCA, ANA, rheumatoid factor, viral serologies, and syphilis testing was performed. Cultures for bacteria, fungi, and Acanthamoeba were negative. The history of PG confirmed by prior skin biopsy was elicited. Corticosteroid therapy was initiated.
Results:
The patient's corneal ulcer, keratoscleritis, and choroidal effusions resolved within 2 weeks of treatment with high-dose topical and oral corticosteroids. Visual acuity improved from hand motion to 20/30, and intraocular pressure normalized. No infectious etiology was identified, and rapid response to steroids excluded active herpetic keratitis.
Conclusion:
Ocular PG can manifest as postoperative keratoscleritis with choroidal effusions. Negative cultures and poor response to antimicrobials should prompt consideration of immune-mediated keratitis. Early recognition and timely corticosteroid therapy can preserve vision. Preoperative risk assessment and perioperative steroid prophylaxis may prevent postoperative inflammatory complications in patients with known PG.
