Conjunctivitis as a manifestation of Wegener's Granulomatosis

Abstract

PurposeTo report a case of prolonged conjunctivitis as the manifestation of Granulomatosis with polyangiitis (GPA).MethodsA 37-year-old man presented with prolonged conjunctivitis which had persisted for one month. He was taking medication for his conjunctivitis without any response. A slit-lamp examination revealed conjunctivitis and scleritis in the right eye. Conjunctivitis, 360-degree peripheral corneal thinning, corneal perforation, and scleritis were seen in the left eye.ResultsEmergency penetrating keratoplasty was performed to treat the patient's corneal perforation. After a consultation with the Internal Medicine Department, the patient was suspected of having GPA with positive cytoplasmic anti-neutrophil cytoplasmic antibodies (C-ANCA). Functional endoscopic sinus surgery was performed to treat right maxillary sinusitis, and a biopsy of the maxillary sinus mucosa was obtained. The pathology report showed granuloma and vasculitis with severe acute and chronic inflammation and few eosinophils; thus, the diagnosis was confirmed.ConclusionBecause prolonged conjunctivitis occurs only rarely in association with systemic disease, ophthalmologists should be aware of this potential, particularly in patients with GPA.

An atypical presentation of granulomatosis with polyangiitis: A case report

“…The initial manifestations can also be ocular in nature. There are cases reported with episcleritis and conjunctivitis as the initial clinical features of GPA [16 , 17] . A case of septal perforation associated with unilateral facial nerve palsy has also been reported [18] .…”

A Case of an Elderly Woman Who Developed Corneal Perforation in the Clinical Course of Myeloperoxidase Positive Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

“…The most common ocular manifestations are eye pain and loss of visual acuity [ 9 ]. In addition, alterations in visual acuity, hyperemia, visual field impairment, and lacrimation have been observed [ 12 ], as have scleritis (22–29%), episcleritis (21–29%), orbital disease (18–21%), lacrimal duct stenosis (10%), and uveitis (9%) [ 9 , 10 ]. Conjunctivitis, keratitis, dacryoadenitis, optic neuritis, retinal detachment, and orbital bone destruction have also been reported.…”

“…However, in our patient, although C-reactive protein and MPO-ANCA titers at the time of previous relapse of scleritis were obviously increased, they did not increase at the time of recent scleritis relapse with corneal perforation. We searched for previous cases of patients with AAV with ocular lesions and extracted case reports that described C-reactive protein and ANCA titers [12,[16][17][18][19][20][21][22][23][24][25][26][27]. We then investigated the relationship between patients with AAV with ocular lesions and Creactive protein levels, as well as ANCA titers (Table 2).…”

The Development of Dry Eye Disease after Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study

“…Recently, the major pathophysiology of DED is speculated as a multi-factorial vicious cycle that leads to inflammatory processes [12]. Since the etiology of CRS is usually related to inflammation [13], a certain association may exist between these two disorders, which has rarely been reported elsewhere.…”