Effective steroid-sparing treatment for peripheral ulcerative keratitis and pyoderma gangrenosum.
OBJECTIVE
To report a patient with a rare clinical presentation of marginal keratitis and pyoderma gangrenosum (PG) that responded to the steroid-sparing agent azathioprine.


METHODS
Interventional case report.


METHODS
Case report and MEDLINE review of the medical literature on PG-associated peripheral ulcerative keratitis (PUK) and its treatment.


RESULTS
A patient with a biopsy-proven history of PG developed an explosive episode of PUK. The ocular inflammation was minimally responsive to topical therapy and required significant long-term oral steroids for control. The patient's active skin lesions and marginal keratitis responded dramatically to systemic oral azathioprine. Since the initiation of treatment with azathioprine, there have been no subsequent recurrences of PG or marginal keratitis.


CONCLUSIONS
PUK may be associated with other inflammatory conditions, such as PG and arthritis. Systemic azathioprine may successfully control ocular and extraocular conditions and should be considered in the clinical setting of topical therapy failure and/or extraocular inflammatory conditions.
Brown
B A
BA
Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC, USA. macula13@erols.com
Parker
C T
CT
Bower
K S
KS
D000284:Administration, Oral; D001379:Azathioprine / Q000008:administration & dosage*; D001706:Biopsy; D003315:Cornea / Q000473:pathology; D003320:Corneal Ulcer / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011241:Prednisone / Q000008:administration & dosage*; D011379:Prognosis; D017511:Pyoderma Gangrenosum / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012867:Skin / Q000473:pathology
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D001379:Azathioprine; D011241:Prednisone