Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
CASE REPORTS
Peripheral Ulcerative Keratitis Associated with Granulomatosis with Polyangiitis Emerging Despite Cyclophosphamide, Successfully Treated with Rituximab
Yuya FujitaShoichi FukuiYushiro EndoSosuke TsujiAyuko TakataniToshimasa ShimizuMasataka UmedaAyako NishinoTomohiro KogaShin-ya KawashiriNaoki IwamotoKunihiro IchinoseMami TamaiHideki NakamuraTomoki OriguchiRyotaro UekiMasafumi UematsuKaori IshidaKuniko AbeAtsushi Kawakami
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JOURNALS OPEN ACCESS

2018 Volume 57 Issue 12 Pages 1783-1788

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Abstract

A 67-year-old Japanese man was diagnosed with granulomatosis with polyangiitis based on the presence of right maxillary sinusitis, proteinase 3 antineutrophil cytoplasmic antibody positivity, and right scleritis. A conjunctival biopsy specimen showed neutrophil-predominant infiltration around the vessels without granuloma. Because there was a risk of blindness, pulsed methylprednisolone and intravenous cyclophosphamide pulse therapy (IVCY) were started. However, it was ineffective, and peripheral ulcerative keratitis newly emerged. We promptly switched the treatment from IVCY to rituximab, and ophthalmologists performed amniotic membrane transplantation, which avoided blindness. The close and effective working relationship between physicians and ophthalmologists improved our patient's ocular prognosis.

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© 2018 by The Japanese Society of Internal Medicine
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