Concomitant herpes simplex keratitis and autoimmune-associated ulcerative keratitis in rheumatoid arthritis patients
Purpose: To describe four cases of concomitant herpes simplex keratitis (HSK) and autoimmune-associated ulcerative keratitis (UK) in patients with rheumatoid arthritis (RA). Observations: All patients developed HSK and UK while undergoing treatment for RA. The average age of onset for RA, UK and HSK...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-06-01
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| Series: | American Journal of Ophthalmology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993619300593 |
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| author | Masaaki Yoshida Takehiro Hariya Shunji Yokokura Wataru Kobayashi Ryu Watanabe Tomonori Ishii Toru Nakazawa |
| author_facet | Masaaki Yoshida Takehiro Hariya Shunji Yokokura Wataru Kobayashi Ryu Watanabe Tomonori Ishii Toru Nakazawa |
| author_sort | Masaaki Yoshida |
| collection | DOAJ |
| description | Purpose: To describe four cases of concomitant herpes simplex keratitis (HSK) and autoimmune-associated ulcerative keratitis (UK) in patients with rheumatoid arthritis (RA). Observations: All patients developed HSK and UK while undergoing treatment for RA. The average age of onset for RA, UK and HSK was 49.3, 69.5 and 70.5 years, respectively. UK preceded HSK in three cases and followed HSK in one case. Two patients had bilateral UK and two had unilateral UK. HSK was unilateral in all cases. All the cases had been treated with immunosuppressive agents including steroid, methotrexate, calcineurin inhibitors, etanercept and tocilizumab at the onset of HSK. Every patient was treated for HSK with topical acyclovir ointment combined with oral valacyclovir. The final visual outcome was extremely poor despite intensive therapy. Conclusions and Importance: These cases raise the possibility that RA patients have an increased risk of HSK, and that HSK may tend to be severe in these patients because of their immunocompromised condition. Furthermore, the complication of HSK and UK in RA patients is difficult to treat because of the atypical clinical manifestation. Thus, the emergence of corneal ulcer, especially in patients with a long clinical history of RA, calls for careful follow-up. |
| first_indexed | 2024-12-17T13:12:26Z |
| format | Article |
| id | doaj.art-abe5cc3b80774890b7ead0ea0abc689c |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-12-17T13:12:26Z |
| publishDate | 2020-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-abe5cc3b80774890b7ead0ea0abc689c2022-12-21T21:47:05ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362020-06-0118Concomitant herpes simplex keratitis and autoimmune-associated ulcerative keratitis in rheumatoid arthritis patientsMasaaki Yoshida0Takehiro Hariya1Shunji Yokokura2Wataru Kobayashi3Ryu Watanabe4Tomonori Ishii5Toru Nakazawa6Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan; Corresponding author. Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, JapanPurpose: To describe four cases of concomitant herpes simplex keratitis (HSK) and autoimmune-associated ulcerative keratitis (UK) in patients with rheumatoid arthritis (RA). Observations: All patients developed HSK and UK while undergoing treatment for RA. The average age of onset for RA, UK and HSK was 49.3, 69.5 and 70.5 years, respectively. UK preceded HSK in three cases and followed HSK in one case. Two patients had bilateral UK and two had unilateral UK. HSK was unilateral in all cases. All the cases had been treated with immunosuppressive agents including steroid, methotrexate, calcineurin inhibitors, etanercept and tocilizumab at the onset of HSK. Every patient was treated for HSK with topical acyclovir ointment combined with oral valacyclovir. The final visual outcome was extremely poor despite intensive therapy. Conclusions and Importance: These cases raise the possibility that RA patients have an increased risk of HSK, and that HSK may tend to be severe in these patients because of their immunocompromised condition. Furthermore, the complication of HSK and UK in RA patients is difficult to treat because of the atypical clinical manifestation. Thus, the emergence of corneal ulcer, especially in patients with a long clinical history of RA, calls for careful follow-up.http://www.sciencedirect.com/science/article/pii/S2451993619300593Herpes simplex keratitisAutoimmune-associated ulcerative keratitisRheumatoid arthritisImmunosuppressive therapyBiological agents |
| spellingShingle | Masaaki Yoshida Takehiro Hariya Shunji Yokokura Wataru Kobayashi Ryu Watanabe Tomonori Ishii Toru Nakazawa Concomitant herpes simplex keratitis and autoimmune-associated ulcerative keratitis in rheumatoid arthritis patients American Journal of Ophthalmology Case Reports Herpes simplex keratitis Autoimmune-associated ulcerative keratitis Rheumatoid arthritis Immunosuppressive therapy Biological agents |
| title | Concomitant herpes simplex keratitis and autoimmune-associated ulcerative keratitis in rheumatoid arthritis patients |
| title_full | Concomitant herpes simplex keratitis and autoimmune-associated ulcerative keratitis in rheumatoid arthritis patients |
| title_fullStr | Concomitant herpes simplex keratitis and autoimmune-associated ulcerative keratitis in rheumatoid arthritis patients |
| title_full_unstemmed | Concomitant herpes simplex keratitis and autoimmune-associated ulcerative keratitis in rheumatoid arthritis patients |
| title_short | Concomitant herpes simplex keratitis and autoimmune-associated ulcerative keratitis in rheumatoid arthritis patients |
| title_sort | concomitant herpes simplex keratitis and autoimmune associated ulcerative keratitis in rheumatoid arthritis patients |
| topic | Herpes simplex keratitis Autoimmune-associated ulcerative keratitis Rheumatoid arthritis Immunosuppressive therapy Biological agents |
| url | http://www.sciencedirect.com/science/article/pii/S2451993619300593 |
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