Autoimmune keratolysis in a patient with leukocytoclastic vasculitis: unusual erythema elevatum diutinum with granulomatous pattern

Cornea
F H CasanovaD de Freitas

Abstract

Leukocytoclastic vasculitis (LCCV) is an immune complex-mediated, small vessel disease that is clinically characterized by the presence of palpable purpuric lesions, most often in association with rheumatic diseases. Ocular manifestations of LCCV are rare. We describe a patient with an unusual granulomatous pattern of erythema elevatum diutinum (EED) associated with autoimmune keratolysis. We studied a 64-year-old man with decreased visual acuity and nodular lesions in both hands. Ocular examination revealed bilateral superior corneal melting with perforation in the left eye and conjunctival thickening in both eyes, in association with a severe inflammatory reaction. Histopathologic examination of the conjunctiva revealed granulomatous vasculitis with neutrophilic infiltrate, giant cells, and fibroblastic proliferation. A punch biopsy taken from his skin showed similar characteristics that suggested EED; however, there were no giant cells. To our knowledge, autoimmune keratolysis secondary to cutaneous LCCV (EED) has not been described previously, and there has been no description of granulomatous reaction (in the conjunctiva) in EED.

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Citations

Mar 5, 2003·American Journal of Ophthalmology·Anthony J AldaveStephen D McLeod
Feb 14, 2004·American Journal of Ophthalmology·Yoshinori MitamuraKenji Ohtsuka
Jan 1, 2011·Indian Dermatology Online Journal·Smitha PrabhuSathish B Pai
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Apr 14, 2007·Clinical & Experimental Ophthalmology·James F T Li YimAlasdair Fern
Oct 8, 2014·Journal of the European Academy of Dermatology and Venereology : JEADV·S E MomenF Al-Niaimi
Mar 22, 2013·Ocular Immunology and Inflammation·Guillermo Rocha, Zale D Mednick
Aug 4, 2018·International Journal of Dermatology·Vladyslava DoktorHerbert Goodheart

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