Álvarez-Guzmán C, González-González LA, Rodríguez-García A

Language: Spanish
References: 13
Page: 61-64
PDF size: 119.75 Kb.

ABSTRACT

Pemphigus vulgaris is an autoimmune disease characterized by intraepidermic blistering, erosions, and crusts in the skin and mucous membranes. The ocular manifestations more commonly observed in this disorder are blepharitis and conjunctivitis. There are few reports in the literature with regarding corneal involvement in patients with pemphigus vulgaris. We present herein a case of ketarolysis in a patient with pemphigus vulgaris that came to our clinic complaining of blurred vision in the right eye, associated with a rapidly progressive corneal erosion. The lesion healed after treatment with topical moxifloxacin 0.5%, the use of a bandage contact lens and aggressive lubrication. We propose an infectious etiology as the cause of the epithelial defect in this case, probably related with the systemic treatment with steroids and immunosuppressive agents that the patient received. An autoinmune mechanism which is characteristic of pemphigus vulgaris, may have also contributed to the cause of the keratolysis in this patient.

REFERENCES

1. Edelson R. Pemphigus-decoding the cellular language of cutaneous autoimmunity. N Engl J Med 2000; 343:60.

2. Lam S. Paraneoplasic Pemphigus. En: Mannis MJ, Macsai MS (Ed). Eye and Skin Disease. Philadelphia, Lipincott-Raven Publishers; 1996. p. 421-423.

3. Pisanti S, Sharav Y, Kaufman E, Posner LN. Pemphigus vulgaris: incidence in Jews of different ethnic groups, according to age, sex, and initial lesion. Oral Surg Oral Med Oral Pathol 1974; 38:382-387.

4. Ahmed AR, Moy R. Death in pemphigus. J Am Acad Dermatol 1982; 7(2):221-228.

5. Chams-Davatchi C, Valikhani M, Daneshpazhooh M y colsl. Pemphigus: analysis of 1209 cases. Int J Dermatol 2005; 44 (6):470-476.

6. Wolff K, Allen R. Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology. New York, Mc Graw Hill, 2005.

7. Zillikens D, Schmidt E, Reimer S, Chimanovitch I y cols. Antibodies to desmogleins 1 and 3, but not to BP180, induce blisters in human skin grafted onto SCID mice. J Pathol 2001; 193 (1):117-124.

8. Daoud Y, Cervantes R, Foster S. Ocular pemphigus. J Am Acad Dermatol 2005; 53(4):585-590.

9. Baykal HE, Pleyer U, Sonnichsen K y cols. Severe ocular involvement in pemphigus vulgaris. Ophtalmologue 1995; 92:854-857. ç

10. Lever W, Goldberg H. The etiology and treatment of pemphigus and pemphigoid. Arch Derm 1969; 100:70.

11. Hodak E, Kermer I, David M y cols. Conjunctival involvement in pemphigus vulgaris: a clinical histopathological and immunofluorescence study. Br J Dermatol 1990; 123:615-620.

12. Suami M, Kato M y cols. Keratolysis in a patient with pemphigus vulgaris. Br J Ophtalmol 2001; 1263-1264.

13. Messent AJ, Blisset MJ, Smith GL y cols. Expression of a single pair for desmosomal glycoproteins renders the corneal epithelium unique amongst stratified epithelis. Invest Ophtalmol Vis Sci 2000; 41:8-15.