Ligneous conjunctivitis in a patient with Crohn′s disease

Abstract

Graciana Fuentes-Páez1, José M Herreras1, M del C Méndez2, MA Saorni1,21Ocular Immunology and Uveitis Unit, Institute of Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain and Hospital Universitario de Valladolid, Spain; 2Ocular Pathology and Lab Registry “Miguel N. Burnier”, Institute of Ophthalmobiology (IOBA), University of Valladolid, Valladolid, SpainObjective: Report the case of a patient with Crohn´s disease and ligneous conjunctivitis.Methods: Interventional case report of a 27-year old female patient, with a 4-year history of Crohn´s disease, was seen for right eye conjunctival ulcer after resolved chemical trauma. Conjunctival biopsy was performed for histopathology, immunofluorescence microscopy, and immunohistochemistry testing.Results: Microbiology tests were negative for bacteria and fungi. PCR was negative for atypical mycobacteria and Herpes. Ocular Crohn´s disease, Whipple disease, and amyloidosis were ruled out. Immunofluorescence microscopy revealed characteristic IgG κ and λ light chain deposits, and fibrin deposition was confirmed through Lendrum´s Martius, Scarlet, and Blue technique. Endogenous plasminogen levels were normal. Recurrent ulcers did not resolve after treatment with infliximab, but only after four surgeries, topical steroids, 1% cyclosporine, heparin (5000 units/ml), and hyaluronidase (1.5 mg/ml). After 9 months of follow-up, nasal symblepharon was observed as sequela.Conclusions: We report the case of a patient with unilateral ligneous conjunctivitis, triggered by chemical injury, and Crohn´s disease.Keywords: Crohn´s disease, immunofluorescence microscopy, ligneous conjunctivitis, plasminogen, ulcerative conjunctivitis