Peripheral Ulcerative Keratitis Secondary to Dupilumab Treatment
Accept poster if oral is not possible ?
Yes
Purpose
To report two cases of peripheral ulcerative keratitis (PUK) secondary to dupilumab treatment for atopic dermatitis.
Methods
Dupilumab is effective in treating various immune-mediated conditions, including as atopic dermatitis, moderate to severe asthma, and allergic rhinitis. Its most common ocular adverse events include conjunctivitis, blepharitis and keratitis. We report a rare case of peripheral ulcerative keratitis, underscoring this potentially serious adverse event.
Results
Case 1: A 46-year-old woman with one-year history of severe atopic dermatitis developed persistent bilateral conjunctival injection and right eye ocular pain after six months of dupilumab treatment. Examination revealed a peripheral corneal ulcer with circumferential progression, despite the discontinuation of dupilumab and the use of topical prednisolone. Immunomodulatory treatment was started with methotrexate 25 mg/week subcutaneously. Due to persistent activity rituximab was added, resulting in complete healing of the ulcer after 3 months.
Case 2: A 27-year-old woman receiving dupilumab treatment for severe atopic dermatitis, with a history of herpetic eye disease under prophylactic acyclovir, reported a white spot on her right eye. Examination revealed conjunctival injection and a perilimbar infiltrate that had not responded to topical prednisolone, and showed circumferential progression. Dupilumab was discontinued, and oral prednisone 16 mg/day was initiated, leading to a favorable response.
Conclusion
While most of ocular complications associated with dupilumab are mild to moderate, some may require careful management, medication adjustments, or even the discontinuation of dupilumab therapy, as seen in the cases of PUK.
Conflict of interest
No
1
Last name
MONTOYA
Initials of first name(s)
J
Department
Uveitis section, ophthalmology department, José de San Martin clinic hospital
City
Buenos Aires
Country
Argentina
2
Last name
GARCÍA
Initials of first name(s)
M
Department
Uveitis section, ophthalmology department, Italian hospital of Buenos Aires
City
Buenos Aires
Country
Argentina
3
Last name
RODRÍGUEZ
Initials of first name(s)
S
Department
Uveitis section, ophthalmology department, Italian hospital of Buenos Aires
City
Buenos Aires
Country
Argentina
4
Last name
SOLER
Initials of first name(s)
T
Department
Uveitis section, ophthalmology department, Italian hospital of Buenos Aires
City
Buenos Aires
Country
Argentina
5
Last name
BURSZTYN
Initials of first name(s)
M
Department
Uveitis section, ophthalmology department, Italian hospital of Buenos Aires
City
Buenos Aires
Country
Argentina
6
Last name
SCHLAEN
Initials of first name(s)
A
Department
Uveitis section, ophthalmology department, Italian hospital of Buenos Aires
City
Buenos Aires
Country
Argentina
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