Tranexamic acid-induced ligneous conjunctivitis with renal failure showed reversible hypoplasminogenaemia.
Ligneous conjunctivitis is a rare severe conjunctivitis characterised by fibrin-rich, 'woody', pseudomembranes on the tarsal conjunctiva complicated by congenital hypoplasminogenaemia. A previous report suggested that ligneous conjunctivitis may result from tranexamic acid (TA)-induced 'secondary' hypoplasminogenaemia. However, the serum plasminogen level has not been confirmed in that scenario. We report for the first time a case of TA-induced ligneous conjunctivitis with reversible hypoplasminogenaemia. A 70-year-old woman developed a gastric ulcer that was treated with oral TA. After 5 weeks of treatment, the patient presented with bilateral pale yellow pseudomembranes on the palpebral conjunctivae. Haematological analysis showed hypoplasminogenaemia. We diagnosed ligneous conjunctivitis. TA was discontinued after 14 weeks after the gastric ulcer symptoms resolved. Six weeks after discontinuation of therapy, the pseudomembranes regressed and the serum plasminogen level returned to the normal range. TA should be considered a possible aetiology in the setting of unresolving ligneous conjunctivitis.
Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
Youngseok
Y
Song
Eye Clinic, Hakodate Goryokaku Hospital, Hakodate, Japan.
Naohiro
N
Izumi
Department of College of Medicine, Texas A&M Health Science Center, Texas A&M University, Temple, Texas, USA.
Luke Benjamin
LB
Potts
Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
Akitoshi
A
Yoshida
D000284:Administration, Oral; D000368:Aged; D003231:Conjunctivitis / Q000139:chemically induced* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D010958:Plasminogen / Q000172:deficiency* / Q000378:metabolism*; D012075:Remission, Spontaneous; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D012873:Skin Diseases, Genetic / Q000139:chemically induced* / Q000503:physiopathology; D013276:Stomach Ulcer / Q000175:diagnosis / Q000188:drug therapy*; D014148:Tranexamic Acid / Q000009:adverse effects* / Q000627:therapeutic use
D014148:Tranexamic Acid; D010958:Plasminogen