Bilateral interstitial keratitis with anterior stromal infiltrates associated with reactive arthritis

Abstract

A previously healthy 48-year-old man presented with a 1-week history of migrating polyarthropathy preceded by a viral illness, dysuria and bilateral red eyes. Ocular examination revealed anterior and interstitial stromal keratitis. He was systemically well but had raised erythrocyte sedimentation rate and C reactive protein and was positive for human leucocyte antigen B27 on extensive infective, rheumatological and autoimmune investigations. Although the exact triggering pathogen was not identified, clinical findings were consistent with reactive arthritis. Bilateral interstitial keratitis is a rare manifestation of reactive arthritis which, along with the anterior stromal keratitis, responded well to topical prednisolone sodium phosphate 0.5%. Systemic joint symptoms improved on oral sulfasalazine, non-steroid anti-inflammatory agent and low-dose prednisolone.

Corneal Ulcer in Reactive Arthritis

“…However, keratitis and corneal ulcer are unusual ocular manifestations of ReA at initial presentation. [4][5][6][7][8][9][10][11] We have presented this case because there seemed to be a coexistence of infectious and immunemediated keratitis in this patient.…”

“…In ReA, the spectrum of keratitis has been described from mild pleomorphic stromal keratitis to corneal ulcers. [4][5][6][7][8][9][10][11] Keratitis in ReA is rare and mostly manifests as a mild pleomorphic anterior stromal keratitis seen in young men, [4][5][6][7][8] with corneal ulcers being distinctly rare. 7,10 We present here the case of a corneal ulcer as an ocular manifestation of ReA.…”

Approaching Reactive Arthritis Associated With Poor Prognostic Factors: A Case Report and Literature Review

“…We analyzed 14 case reports and four large-scale studies that are pertinent for our discussion. The case reports and the large studies are displayed in Table 4 [3][4][5][6][7][8][9][10][11][12][13][14][15][16] and Table 5 [17][18][19][20], respectively. We risk-stratified the case reports by poor prognostic factors and analyzed the treatment options in the order they were used in each case study.…”

“…Five case reports documented the use of oral steroids as the second choice of therapy after non-relief with NSAIDs [8][9][10][11]14,16]. Case number 8 ( Table 4) initiated oral steroids as a first line therapy, followed by DMARD therapy for additional symptom control [11].…”

“…Case number 10 chose oral steroid after trial of NSAID and DMARD therapy for symptomatic management [16]. Out of these five cases which required oral steroids after failure with NSAIDs, one case presented with five poor prognostic factors, two cases with four poor prognostic factors, one with three poor prognostic factors and one with two poor prognostic factors [8][9][10]14]. They uniformly required the use of DMARDs.…”