Posters

A new clinical entity: post-streptococcal numular keratitis

Poster Details

First Author: I.Said MOROCCO

Co Author(s): E. Nihad   B. Hatim   L. Jaouad   B. Adil   A. Laktaoui        

Abstract Details

Purpose:

Post-streptococcal nummular keratitis is a new entity. it is characterized by large infiltrates in the cornea. It can be unilateral or bilateral. Its mechanism is probably immunoallergic. We report the first two cases of nummular keratitis related to a post-streptococcal disease and we describe its clinical appearance.

Setting:

Ophthalmology service of Moulay Ismail military hospital Meknes

Methods:

We report two clinical case of fnummular keratitis seen in Ophthalmology service of Moulay Ismail military hospital Meknes in 2019

Results:

Case 1: 10-year-old boy, followed for chronic nummular keratitis, resistant to local antiviral and steroids. Case 2: Six-year-old girl with recurrent sore throats and scarlet fever a year ago, cames for a left red eye . Examination revealed a nodular episcleritis resistant to non-steroidal anti-inflammatory drugs ,one month later, corneal nummular infiltrates appears: whitish plates in anterior stromal. In both cases, we found an inflammatory syndrom with high ASLO title. The throat swabbing found pyogenic streptococcus. Post-streptococcal syndrome was identified as a cause, after excluding other disease .We started oral co-amoxiclav and artificial tears. The evolution was spectacular without recurrence.

Conclusions:

Diagnosis of post-streptococcal numular keratitis should be made only after excluding other causes: viral, brucellosis, sarcoidosis, tuberculosis; syphilis, ocular amoebiasis, and Hyper-IgD. It is a new clinical entity, characterized by rounded whitish lesions  localized in the anterior stroma. These lesions are made of radial infiltrates  giving a “wheel radius” appearance. Over time, these infiltrates are more prone to confluence and the plaques take on a "coin" appearance similar to that described by "Demmer". The corneal sensitivity is conserved. This keratitis can be unilateral or bilateral and associated with inflammatory syndrome, high ASLO titre, and streptococcal infection.

Financial Disclosure:

None