Undercover ocular pemphigoid

Abstract

Objective: Report a case of corneal abscess of torpid evolution and difficult resolution in a patient with ocular pemphigoid undiagnosed as the base disease.

Case report: A forty-one-year-old male was brought into examination with a diagnosis of trauma with a metallic foreign body in the right eye and discomfort in the left eye. After an ophthalmological examination, a best corrected visual acuity (BCVA) of 1/10 was discovered in both eyes. From the biomicroscopy an annular abscess of corneal tissue, corneal edema, folds in Descemet’s membrane and 360° corneal ulcers in the right eye were discovered, while the left eye presented corneal edema and folds in Descemet’s membrane. A sampling was taken for direct and breeding ground for bacteria and fungi, and a PCR for detecting Acanthamoeba, which resulted in a positive PCR for Acanthamoeba. A triple therapeutic plan in the left eye was initiated and Autogenic serum was prescribed in the left eye. In the following checkups, a chronic development with a higher corneal trauma was spotted in both eyes in spite of the treatment given. A conjunctival biopsy of ocular pemphigoid was performed, since it gathered all the histomorphological features of the pathology. Systemic treatment for pemphigoid was started, confirming a favorable development of the case.

Conclusion: Highlight the importance of maintaining a high degree of suspicion for auto-immune diseases such as ocular pemphigoid of torpid evolution in spite of effective treatment.