Posters

Peripheral corneal ulcer in 15 year old patient with Crohn’s disease and epidermolysis bullosa: management and treatment

Poster Details

First Author: J. Fajardo Sanchez SPAIN

Co Author(s): C. Chau Ramos   N. Moura-Coelho                 

Abstract Details

Purpose:

Epidermolysis bullosa acquisita is extremely rare in childhood and it has been reported to be frequently associated with Crohn's disease. Our main purpose is to describe the characteristics, evolution by images and treatment of a progressive corneal ulcer in a 15 year old patient with Crohn's disease in association with epidermolysis bullosa acquisita and to review the recent literature for new terapies and treatment possibilities.

Setting:

Lima, Peru

Methods:

Holistic approach and study of the case with Immunology, Gastroenterology and Dermatology, high quality images of the cornea and the lesion, topographic changes and extensive literature search.

Results:

A 15-year old patient with a 2-year history of Crohn's disease presented with a peripheral corneal ulcer of the right eye. Corneal smears displayed no bacterial growth. Visual acuity of the right eye was 20/25. Adicionally, he had developed cutaneous blisters confirmed as epidermolysis bullosa acquisita. Despite treatment with topical antibiotics and systemic immunosuppressive therapy the corneal manifestation deteriorated. An amniotic membrane was transplanted; however, this was followed by melting. Additional therapeutic procedures including further amniotic membrane transplantations were performed and finally when the Crohn’s disease was stable one succeed to stayed attached and the epithelium grew again.

Conclusions:

Corneal complications in patients with Crohn's disease are very rare in contrast to conjunctivitis, episcleritis und uveitis. As far as we are concerned, this is the first description of a very young patient with Crohn's disease and epidermolysis bullosa acquisita developing a resistant corneal ulcer. How an autoimmune mechanism in the cornea is related to Crohn's disease or epidermolysis bullosa acquisita, is not known, but the most stable the inmune diseases are the better to control and assure that the cornea is not attacked as an inmune target.

Financial Disclosure:

None