Obliterative microangiopathy presenting as chronic conjunctivitis in a patient with relapsing polychondritis.
OBJECTIVE
To report histopathologic findings and treatment of obliterative microangiopathy in a patient with chronic conjunctivitis due to relapsing polychondritis (RP).


METHODS
This interventional case report describes a 50-year-old woman with relapsing polychondritis was referred to the Ocular Immunology and Uveitis Service for bilateral tearing due to refractory chronic conjunctivitis. Ocular examination revealed the presence of bilateral follicular conjunctivitis. Conjunctival biopsy of the inferior palpebral conjunctiva was performed, and the histopathologic findings guided the therapeutic intervention.


RESULTS
The pathology of the conjunctival biopsy included granulomatous obliterative microangiopathy with numerous eosinophils, plasma cells, lymphocytes, and epithelioid cells in the substantia propia. The chronic conjunctivitis resolved with systemic methotrexate therapy.


CONCLUSIONS
Microangiopathy may cause chronic conjunctivitis in patients with RP and may be a harbinger of evolving nonocular problems as a consequence of incomplete control of this autoimmune disorder. Immunomodulatory therapy should be considered in such cases to prevent possible cardiovascular, renal, respiratory, and neurologic complications of vasculitis. Although methotrexate has been used in treatment of RP-related necrotizing scleritis with poor results, it can be sufficient for the conjunctivitis with microangiopathy associated with RP.
Yu
Ellen N
EN
Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research Surgery Institute, Harvard Medical School, Boston, MA 02142, USA.
Jurkunas
Ula
U
Rubin
Peter A D
PA
Baltatzis
Stefanos
S
Foster
C Stephen
CS
D002908:Chronic Disease; D003228:Conjunctiva / Q000098:blood supply*; D003231:Conjunctivitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011081:Polychondritis, Relapsing / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014657:Vasculitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
D007166:Immunosuppressive Agents; D008727:Methotrexate