title: Peripheral Ulcerative Keratitis Secondary to Chronic Hepatitis B Infection.
abstract: OBJECTIVE
  To report a unique case of peripheral ulcerative keratitis secondary to hepatitis B virus (HBV)-associated cryoglobulinemia and vasculitis and its pharmacological and surgical treatment and 2-year follow-up.
  
  
  METHODS
  A 52-year-old woman presented with unilateral eye pain and photophobia, arthralgia, remnants of a maculopapular rash, and subsequently facial numbness several weeks later. Her best spectacle-corrected visual acuity (BSCVA) in the affected eye was 20/80. Slit-lamp examination revealed severe superior corneal thinning without infiltrate. Corneal ulceration worsened until 10% of the cornea remained. Laboratory workup was positive for rheumatoid factor and revealed significantly decreased C4 complement, and HBV serology was positive.
  
  
  RESULTS
  Clinical history, examinations, and laboratory results suggest HBV-associated cryoglobulinemia and vasculitis. Management included prednisone, cyclophosphamide, and mycophenolate mofetil for immunosuppression and tenofovir for HBV treatment. Conjunctival resection and a glue patch were used to reduce inflammation and stabilize corneal melt. BSCVA improved after treatment was initiated. Two years after initial presentation, her BSCVA is 20/30, significantly improved from her vision at presentation.
  
  
  CONCLUSIONS
  Diagnosis of peripheral ulcerative keratitis requires thorough history and physical examinations given the numerous causes. Prompt treatment including immunosuppressive medication and, in this case, antiviral medication is crucial to preventing serious visual consequences including corneal perforation and blindness.
authors.affiliation: *Queen's University School of Medicine, Kingston, Ontario, Canada; †Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; and ‡Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David W
authors.initials: DW
authors.lastname: Wei
authors.forename: Christian
authors.initials: C
authors.lastname: Pagnoux
authors.forename: Clara C
authors.initials: CC
authors.lastname: Chan
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D003449:Cryoglobulinemia / Q000150:complications / Q000188:drug therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D013508:Ophthalmologic Surgical Procedures; D011241:Prednisone / Q000627:therapeutic use; D000068698:Tenofovir / Q000627:therapeutic use; D014657:Vasculitis / Q000150:complications / Q000188:drug therapy
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D000068698:Tenofovir; D009173:Mycophenolic Acid; D011241:Prednisone