Painful Acute Corneal Ulceration and Anterior Stromal Keratitis in an Adolescent With Reactive Arthritis

Abstract

Reactive arthritis is occasionally associated with conjunctivitis and uveitis, but rarely keratitis. The authors describe a patient with paracentral anterior stromal keratitis with overlying epithelial erosion and multiple satellite subepithelial infiltrates. The initial appearance and the severe pain were suggestive of an infectious process. Recovery was rapid following introduction of topical steroid, with features suggesting an immune process in the recovery phase. The authors suggest that a history of arthritis and/or recent enteritis should be sought in the work-up of an atypical keratitis with or without epithelial defect. [J Pediatr Ophthalmol Strabismus. 2016;53:e61-e63.].

Corneal Ulcer in Reactive Arthritis

“…Lyons et al reported a patient with an atypical paracentral corneal ulcer with anterior stromal infiltrates mimicking microbial keratitis. 10 Our patient seems to closely resemble these cases. Microbiological evaluation revealed S. hominis in our patient, which is a commensal, though it is also known to cause infections.…”

“…Lyons reported a similar approach in their case. 10 Our case was probably a mixed pathology of superadded infection with infl ammation due to ReA. Despite the epithelial healing, he was still symptomatic and had persistent pleomorphic anterior stromal infi ltrates.…”

“…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.…”

“…Keratitis in ReA presenting as a central epithelial defect with an underlying dense, anterior stromal infi ltrate has been described earlier in two reports. 7,10 Mark et al reported a case of ReA with bilateral sequential shallow corneal ulcers for which they initiated topical steroids. 7 One eye improved, but the other developed a hypopyon, and so steroids were discontinued immediately.…”

“…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.…”