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Case Report
Corneal melt in a patient with rheumatoid arthritis on methotrexate and tofacitinib
1 Department of Ophthalmology, Howard University School of Medicine, Washington, DC, USA
2 Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
3 Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
4 Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
Address correspondence to:
Miriam B Michael
Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD,
USA
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Article ID: 100007O02NN2022
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How to cite this article
Nguyen NS, Lai WC, Ling C, Brown D, Rajpal S, Markidan J, Michael MB. Corneal melt in a patient with rheumatoid arthritis on methotrexate and tofacitinib. Edorium J Ophthalmol 2022;5(2):5–10.ABSTRACT
Introduction: Peripheral ulcerative keratitis (PUK) is a rare finding with a severely destructive ophthalmological emergency that typically manifests in patients with a chronic history of untreated or uncontrolled autoimmune diseases, with the most common being rheumatoid arthritis (RA).
Case Report: We present a rare case of a patient with well-controlled rheumatoid arthritis without flares for many years on methotrexate and tofacitinib who presented with rapidly progressing loss of vision and pain in the right eye due to corneal melt. She was found to have a right perforated cornea secondary to corneal melt from peripheral ulcerative keratitis (PUK) with pathology showing active inflammation. She was evaluated by the Ophthalmology and Rheumatology teams and was started on topical steroid and antibiotic eye drops alongside oral prednisone 40 mg daily. She then underwent a penetrating keratoplasty two days later. On postoperative follow-up visits, her visual acuity and ophthalmic exam remained stable with an intact graft. In patients with a longstanding history of autoimmune diseases presenting with rapid progression of eye pain, vision loss, and/or other ocular symptoms, urgent ophthalmic and rheumatologic evaluations and aggressive management with systemic immunosuppression and/or surgery are indicated to prevent poor ophthalmic outcomes and a high mortality rate.
Conclusion: Corneal melt should be considered in a patient with autoimmune diseases who presents with eye symptoms. Peripheral ulcerative keratitis should be recognized and treated early and aggressively to avoid severe complication.
Keywords: Corneal melt, Peripheral ulcerative keratitis, Rheumatoid arthritis, Tofacitinib
SUPPORTING INFORMATION
Acknowledgments
There are no significant parties that have contributed to the case report that have not been acknowledged as a patient, writer, or reference.
Author ContributionsNguyen Sy Nguyen - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Wei Chen Lai - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Carlthan Ling - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Douglas Brown - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sachin Rajpal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Janina Markidan - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Miriam B Michael - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Nguyen Sy Nguyen et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
