Bilateral disciform keratitis in Reiter's syndrome

Abstract

Reiter's syndrome is commonly associated with conjunctivitis and rarely with uveitis. Bilateral disciform keratitis at presentation is a very rare manifestation in Reiter's syndrome. A 13-year-old boy developed bilateral disciform keratitis with oligoarthritis following an episode of conjunctivitis. In addition he had suspected bacterial keratitis with hypopyon in the left eye as a possible secondary infection of an epithelial defect that is a feature of Reiter's keratitis. Empirical treatment with intensive topical antibiotics as a therapeutic trial completely resolved the hypopyon and the disciform keratitis settled with topical steroid treatment. The patient achieved a best corrected vision of 20/20 in both the eyes 6 weeks after the treatment. Bilateral disciform keratitis can occur as a complication of Reiter's syndrome. Also the possibility of secondary infection of the epithelial defect needs to be borne in mind.

Bilateral Disciform Keratitis with Immune Corneal Ring in a Patient with HLA-B27 Positive Reactive Arthritis

“…3 Suresh in 2016 reported bilateral disciform keratitis in a 13 year old boy, with intact epithelium in one eye and entire corneal involvement with epithelial defect and hypopyon in the other. 4 Khandgave in 2015 reported bilateral disciform keratitis in a 13 year old girl, nonresponsive to antivirals but improved only by systemic and topical steroids. 5 Though our patient had occasional mild joint pain for 8 years and was on improper treatment, HLAB27 related spondyloarthritis was diagnosed after multiple joint involvement occurred a week following bacterial UTI.…”

Reactive arthritis – an interdisciplinary issue

“…However, having applied advanced diagnostic techniques, it was possible to isolate Chlamydia from the conjunctival sac only in 4% of patients. Other symptoms include iritis, uveitis, episcleritis, corneal ulceration, and cystoid macular oedema with posterior uveitis [30].…”

“…Początkowo przypisywano to obecności artogennych drobnoustrojów w narządzie wzroku, jednak po zastosowaniu specjalistycznych technik diagnostycznych jedynie u 4% chorych udało się wyizolować Chlamydia z worka spojówkowego. Inne objawy ze strony narządu wzroku to: zapalenie tęczówki (iritis), zapalenie błony naczyniowej (uveitis), zapalenie twardówki (episcleritis), owrzodzenia rogówki, cystowaty obrzęk i degeneracja plamki żółtej (cystoid macular oedema) przy zapaleniu tylnej części błony naczyniowej oka (posterior uveitis) [30].…”

Uveíte como primeira manifestação de espondiloartrite: relato de casos

“…A Artrite Reativa, é representada pela tríade clássica: artrite, uretrite e conjuntivite 9,10 . A conjuntivite é o sintoma ocular mais prevalente (30 a 60%), seguido de uveíte anterior não granulomatosa, sinequiante, bilateral e assimétrica, que acomete principalmente homens jovens 10,11 .…”

“…A Artrite Reativa, é representada pela tríade clássica: artrite, uretrite e conjuntivite 9,10 . A conjuntivite é o sintoma ocular mais prevalente (30 a 60%), seguido de uveíte anterior não granulomatosa, sinequiante, bilateral e assimétrica, que acomete principalmente homens jovens 10,11 . Para definição do diagnóstico, deve-se correlacionar achados clínicos e epidemiológicos, além dos sintomas oculares, os pacientes podem apresentar dor articular, úlceras orais, diarreia crônica e uretrite 12,13 .…”