Peripheral ulcerative keratitis associated with erythema elevatum diutinum and a positive rheumatoid factor: a report of three cases

Abstract

Peripheral ulcerative keratitis (PUK) is a complication of collagen-vascular diseases such as rheumatoid arthritis (RA) and other systemic vasculitides. We report three cases of erythema elevatum diutinum with PUK. These patients presented with nodules and plaques consistent with erythema elevatum diutinum on the extremities and crusted or ulcerated purpuric lesions on the soles. Histopathological examination of these lesions revealed a dense neutrophilic infiltrate with nuclear dust and fibrin around blood vessels. All the patients developed PUK concomitant with the development of the skin lesions. The rheumatoid factor was positive at high titre in all three patients; this was associated with probable RA in one. Cutaneous lesions were dramatically improved by administration of dapsone in all cases. Dapsone was also effective in treating the ocular lesions in two patients.

A case of erythema elevatum diutinum associated with peripheral ulcerative keratitis

“…4 Cases of EED associated with PUK are rare, with very few described in the literature. 1,5,6 Herein, we report on a case with biopsyproven EED associated with PUK, which, unlike previously reported cases, coexisted with RA and positive rheumatoid factor.…”

Intravascular or intralymphatic histiocytosis associated with rheumatoid arthritis: a report of 4 cases

“…Rheumatoid vasculitis from systemic arteritis to mild cutaneous vasculitic lesions 5 and related diseases, such as pyoderma gangrenosum and erythema elevatum diutinum, are also well recognized to be associated with RA. 6,7 We encountered 4 patients with RA at 3 different hospitals who had developed irregular erythematous patches over and around the elbow joints. These patients showed a similar clinical appearance and specific histopathologic findings, ie, histiocytic aggregates in markedly dilated blood or lymph vessels in the dermis.…”

Erythema elevatum diutinum and plastic surgery Case report

“…Hernandez-Cano et al reported the disappearance of EED lesions in a patient with a liver transplantation following a reduction in cyclosporin dosage [12]. However, EED lesions may not respond to dapsone, or if they do, recurrences are quite common [5,11,24,31,39]. It is possible that the marked fibrosis in late lesions may account for the lack of response to dapsone [8].…”

“…Other conditions reported to be associated include hyperimmunoglobulinemia D syndrome, cryoglobulinemia, myelodysplastic syndromes, abnormalities in the clotting mechanism, haematological malignancies, prostatic carcinoma, testicular lymphoma, viral and bacterial infections, rheumatic fever, HIV infection, inflammatory bowel disease, rheumatoid arthritis and peripheral ulcerative keratitis, relapsing polychondritis, Wegener's granulomatosis, and acro-osteolysis [1,9,10,16,18,23,24,37,39,40,41,42].…”