Peripheral ulcerative keratitis with corneal melt as the primary presentation in a case of human immunodeficiency virus

Abstract

Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It is thought to be the result of immune complex deposition at the limbus, resulting in corneal inflammation and stromal melt. We present a case of a 43-year-old female patient of African origin, presenting with PUK and associated corneal perforation as the primary presentation of HIV infection. An urgent tectonic deep anterior lamellar keratoplasty was performed under general anaesthesia with excellent outcome. The patient was referred to the sexual health clinic and anti-retroviral treatment was initiated. This case is to the best of our knowledge the first report from the UK of PUK with corneal perforation as the primary presentation of HIV infection. As highlighted in this report, infection with HIV may initially be silent; therefore, it is vital to consider HIV infection when dealing with PUK of unknown aetiology.

Peripheral ulcerative keratitis: A review of aetiology and management

“…Cat scratch disease 65 Herpes simplex 63,66,67,68 Lyme disease 69 Herpes zoster 63,70 Fungal Viral HIV 35,37,38,39,40,41,42…”

“…36 HIV has been described as a cause of PUK in several case reports. 35,37,38,39,40,41,42 This association has been made in newly diagnosed patients with no co-morbid conditions or in the presence of conditions associated with PUK. 38,39,42 These associated conditions were mostly infective in nature and included tuberculosis, herpes zoster ophthalmicus, RA, and syphilis.…”

“…35,37,38,39,40,41,42 This association has been made in newly diagnosed patients with no co-morbid conditions or in the presence of conditions associated with PUK. 38,39,42 These associated conditions were mostly infective in nature and included tuberculosis, herpes zoster ophthalmicus, RA, and syphilis. 35,37,40,41 All the patients who had HIV as an isolated risk for PUK required only local therapy and initiation of HAART in order to achieve disease control, suggesting that HIV alone is not an aggressive factor for the development of PUK.…”

A Case of Bilateral Peripheral Ulcerative Keratitis

“…Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning [1]. It involves crescent-shaped corneal ulcers adjacent to the limbus.…”

“…Systemic causes may be infectious or non-infectious. PUK may precede the diagnosis of the systemic condition and therefore these cases require urgent investigation [1]. generally, PUK appears late and usually signals worsening of a systemic disease [3].…”