PURPOSE: To demonstrate the effectiveness of Rituximab in the management of peripheral ulcerative keratitis (PUK) associated with Wegener granulomatosis (WG). METHODS: A 50-year-old female with WG, confirmed by skin biopsy and positive anti-neutrophil cytoplasmic antibodies 3 years prior, was presented with a corneoscleral granulomatous mass that affected the superior limbus and with vasculitic PUK in the right eye. The mass was treated daily with oral prednisone (1 mg.kg-1.d-1) in conjunction with weekly maintenance treatment of 10 mg of methotrexate. After 2 months of treatment, the volume of the nodular granulomatous lesion decreased. However, the PUK and corneal thinning persisted, which presented a risk for corneal perforation. Subsequently, two 1000-mg infusions of rituximab were administered at weekly intervals. RESULTS: One week after the first administration of rituximab, we observed persistence of corneal thinning, flattening of the nodular lesion, and disappearance of the necrotic foci. After the second rituximab treatment, the patient exhibited no signs of corneal perforation and we further observed total epithelialization of the PUK. No systemic side effects were seen. After 2 months, no nodular lesion was observed, although conjunctival epithelialization from the previous PUK remained. Weekly methotrexate and 10 mg of prednisone per day were maintained. CONCLUSIONS: Rituximab seems to offer therapeutic promise in the treatment of refractory PUK associated with WG. Rituximab may be the elective treatment for severe anterior ocular inflammation associated with risk for corneal perforation, as a result of WG.
PURPOSE: To demonstrate the effectiveness of Rituximab in the management of peripheral ulcerative keratitis (PUK) associated with Wegener granulomatosis (WG). METHODS: A 50-year-old female with WG, confirmed by skin biopsy and positive anti-neutrophil cytoplasmic antibodies 3 years prior, was presented with a corneoscleral granulomatous mass that affected the superior limbus and with vasculitic PUK in the right eye. The mass was treated daily with oral prednisone (1 mg.kg-1.d-1) in conjunction with weekly maintenance treatment of 10 mg of methotrexate. After 2 months of treatment, the volume of the nodular granulomatous lesion decreased. However, the PUK and corneal thinning persisted, which presented a risk for corneal perforation. Subsequently, two 1000-mg infusions of rituximab were administered at weekly intervals. RESULTS: One week after the first administration of rituximab, we observed persistence of corneal thinning, flattening of the nodular lesion, and disappearance of the necrotic foci. After the second rituximab treatment, the patient exhibited no signs of corneal perforation and we further observed total epithelialization of the PUK. No systemic side effects were seen. After 2 months, no nodular lesion was observed, although conjunctival epithelialization from the previous PUK remained. Weekly methotrexate and 10 mg of prednisone per day were maintained. CONCLUSIONS:Rituximab seems to offer therapeutic promise in the treatment of refractory PUK associated with WG. Rituximab may be the elective treatment for severe anterior ocular inflammation associated with risk for corneal perforation, as a result of WG.
Authors: Tania Sales de Alencar de Fidelix; Luis Antonio Vieira; Denise de Freitas; Virginia Fernandes Moça Trevisani Journal: Int Ophthalmol Date: 2015-08-29 Impact factor: 2.031
Authors: Kiana Hassanpour; Reem H ElSheikh; Amir Arabi; Charles R Frank; Abdelrahman M Elhusseiny; Taher K Eleiwa; Shiva Arami; Ali R Djalilian; Ahmad Kheirkhah Journal: J Ophthalmic Vis Res Date: 2022-04-29
Authors: Claudia Recillas-Gispert; Juan Carlos Serna-Ojeda; Luis Felipe Flores-Suárez Journal: Graefes Arch Clin Exp Ophthalmol Date: 2015-10-27 Impact factor: 3.117
Authors: Hans-Peter Tony; Gerd Burmester; Hendrik Schulze-Koops; Mathias Grunke; Joerg Henes; Ina Kötter; Judith Haas; Leonore Unger; Svjetlana Lovric; Marion Haubitz; Rebecca Fischer-Betz; Gamal Chehab; Andrea Rubbert-Roth; Christof Specker; Jutta Weinerth; Julia Holle; Ulf Müller-Ladner; Ramona König; Christoph Fiehn; Philip Burgwinkel; Klemens Budde; Helmut Sörensen; Michael Meurer; Martin Aringer; Bernd Kieseier; Cornelia Erfurt-Berge; Michael Sticherling; Roland Veelken; Ulf Ziemann; Frank Strutz; Praxis von Wussow; Florian M P Meier; Nico Hunzelmann; Enno Schmidt; Raoul Bergner; Andreas Schwarting; Rüdiger Eming; Michael Hertl; Rudolf Stadler; Michael Schwarz-Eywill; Siegfried Wassenberg; Martin Fleck; Claudia Metzler; Uwe Zettl; Jens Westphal; Stefan Heitmann; Anna L Herzog; Heinz Wiendl; Waltraud Jakob; Elvira Schmidt; Klaus Freivogel; Thomas Dörner Journal: Arthritis Res Ther Date: 2011-05-13 Impact factor: 5.156