mycophenolic-acid and Corneal-Ulcer

To report a unique case of peripheral ulcerative keratitis secondary to hepatitis B virus (HBV)-associated cryoglobulinemia and vasculitis and its pharmacological and surgical treatment and 2-year follow-up.. A 52-year-old woman presented with unilateral eye pain and photophobia, arthralgia, remnants of a maculopapular rash, and subsequently facial numbness several weeks later. Her best spectacle-corrected visual acuity (BSCVA) in the affected eye was 20/80. Slit-lamp examination revealed severe superior corneal thinning without infiltrate. Corneal ulceration worsened until 10% of the cornea remained. Laboratory workup was positive for rheumatoid factor and revealed significantly decreased C4 complement, and HBV serology was positive.. Clinical history, examinations, and laboratory results suggest HBV-associated cryoglobulinemia and vasculitis. Management included prednisone, cyclophosphamide, and mycophenolate mofetil for immunosuppression and tenofovir for HBV treatment. Conjunctival resection and a glue patch were used to reduce inflammation and stabilize corneal melt. BSCVA improved after treatment was initiated. Two years after initial presentation, her BSCVA is 20/30, significantly improved from her vision at presentation.. Diagnosis of peripheral ulcerative keratitis requires thorough history and physical examinations given the numerous causes. Prompt treatment including immunosuppressive medication and, in this case, antiviral medication is crucial to preventing serious visual consequences including corneal perforation and blindness.

Topics: Antiviral Agents; Corneal Ulcer; Cryoglobulinemia; Cyclophosphamide; Female; Glucocorticoids; Hepatitis B, Chronic; Humans; Immunosuppressive Agents; Middle Aged; Mycophenolic Acid; Ophthalmologic Surgical Procedures; Prednisone; Tenofovir; Vasculitis

Topics: Antiviral Agents; Cidofovir; Combined Modality Therapy; Corneal Ulcer; Cowpox; Cowpox virus; Cytosine; DNA, Viral; Eye Infections, Viral; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Keratoplasty, Penetrating; Middle Aged; Mycophenolic Acid; Organophosphonates; Real-Time Polymerase Chain Reaction; Reoperation; Virus Activation; Visual Acuity

Topics: Administration, Topical; Corneal Ulcer; Drug Therapy, Combination; Erythromycin; Female; Functional Laterality; Humans; Immunosuppressive Agents; Kidney Transplantation; Lubrication; Middle Aged; Mycophenolic Acid; Tacrolimus

Pemphigus vulgaris, or PV, is a potentially life-threatening illness that manifests itself initially in the mouth in the majority of patients. Paradoxically, it is less commonly recognized when it involves lesions on the oral mucosa rather than on the skin.. This article describes the clinical presentation of 42 cases of oral PV evaluated and diagnosed by dentists. Emphasis is placed on the common distribution and appearance of oral PV lesions and diagnosis of the disease.. The dentist has a unique opportunity to recognize the oral presentation of PV and contribute to an early diagnosis and, therefore, an improved treatment outcome.

Topics: Adult; Aged; Anti-Inflammatory Agents; Autoantibodies; Azathioprine; Corneal Ulcer; Cyclophosphamide; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Mycophenolic Acid; Oral Ulcer; Pemphigus; Prednisolone