Case reportPolymicrobial and microsporidial keratitis in a patient using Boston scleral contact lens for Sjogren's syndrome and ocular cicatricial pemphigoid
Introduction
Sjogrens syndrome is a systemic autoimmune disease occurring more commonly in females and affecting the lacrimal and salivary glands causing dry eye and dry mouth [1]. Ocular cicatricial pemphigoid is a chronic cicatrizing autoimmune disease of the mucous membrane and skin occurring predominantly in females, due to auto antigens directed against α4β6 integrin in the epithelial basement membrane [2]. Each of these conditions has severe ocular surface disease requiring preservative free artificial tears, topical cyclosporine A, punctal plugs [3] and scleral contact lenses [4]. It is believed that these patients are at a higher risk of developing microbial keratitis [5].
Microsporidia are ubiquitous organisms causing systemic and ocular infections in humans [6]. Ocular features include superficial keratoconjunctivitis in immuno-suppressed persons and stromal keratitis in immuno-competent persons [6].
We describe the rare occurrence of microsporidial stromal keratitis with polymicrobial keratitis in a patient with secondary Sjogren's syndrome and ocular cicatricial pemphigoid who was using a Boston scleral contact lens.
Section snippets
Case report
A 66-year-old lady was diagnosed with ocular cicatricial pemphigoid (OCP) and secondary Sjogrens’ syndrome (SS) in 2004 and presented to the Cornea services at L V Prasad Eye Institute, Hyderabad, India with complaints of dryness in both eyes and loss of vision in the left eye. She had positive immunohistochemistry for OCP and the triad of dry eye, dry mouth and sero-negative rheumatoid arthritis with positive anti Ro and anti La titers and a positive lip biopsy. Her best-corrected visual
Discussion
Our patient was an HIV negative lady with Sjogren's syndrome and OCP, who developed a rapidly progressive polymicrobial keratitis with S. epidermidis, C. accolens and Microsporidia following use of a Boston scleral contact lens.
Patients with ocular surface disease are at an increased risk of developing microbial keratitis [5]. S. epidermidis and Corynebacterium spp. are commensals present in the conjunctival sac [9] and hence this could be a potential source of infection in patients with severe
Conflict of interest
The authors have no financial or proprietary interest in any of the methods or materials used in this study.
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