Posters

Intravenous immunoglobulin therapy in patient with ocular mucous membrane pemphigoid: a case report

Poster Details

First Author: H.Donoso Torres SPAIN

Co Author(s):    B. Garcia-Valcarcel Gonzalez   V. Osuna Vazquez   L. Ibares Frias              

Abstract Details

Purpose:

The purpose of this study is to report a patient who present ocular mucous membrane pemphigoid (OMMP) who underwent treatment with intravenous immunoglobulin in alternative to classical immunosuppressive agents.

Setting:

Unit of Cornea, Ophthalmology Department, Hospital Gregorio Marañon, Madrid (Spain).

Methods:

Retrospective study of a patient with OMMP who underwent intravenous inmunoglobulin therapy in our centre. The following of the patient was made with serial photographies, ophthalmologic exploration with the slit lamp (SL) grading conjunctival hiperemia and the stage of fibrosis and topographies with Pentacam (Oculus). Patient of 70 years old with OMMP from 10 years back. The best corrected visual acuity was 0.3 in both eyes. The exploration in the SL reveals conjunctival hiperemia +2, distichiasis, subepithelial fibrosis of upper and lower tarsal conjuctiva (symblepharon) with shortening of the fornix. OMMP stage 3.

Results:

The patient was receiving topical therapy with cyclosporine A 1% and autologous serum tears 20%, needing occasionally oral doxycycline and corticosteroids drops as a rescue therapy. The patient present multiples systemic pathologies that contraindicated classical systemic immunosuppressive therapy, also was detected a deficit in IgG4 and IgM patient levels, so was decided to begun with cycles of 20g intravenous immunoglobulin every 3 weeks. Two years later the patient stays with good response to therapy, clinical improvement with less symptoms and a decrease in conjunctiva inflammation to grade +1 without any new fibrosis.

Conclusions:

The OMMP is an autoimmune disease with potentional devastating consequences if a correct systemic therapy is not established. Therapy with intravenous immunoglobulin supposed a safe and effective alternative in patients with multiples systemic pathologies that contraindicate the use of immunosuppressive agents.

Financial Disclosure:

None