Wilson D M, John G R, Callen J P
Department of Medicine, University of Louisville School of Medicine, Kentucky, USA.
J Am Acad Dermatol. 1999 Feb;40(2 Pt 2):331-4. doi: 10.1016/s0190-9622(99)70479-2.
The term peripheral ulcerative keratitis represents a spectrum of inflammatory diseases, characterized by cellular infiltration, corneal thinning, and ulceration. Neutrophilic dermatoses are rarely associated with peripheral ulcerative keratitis. To date, peripheral ulcerative keratitis has only been reported in patients with pyoderma gangrenosum. Separate episodes of pyoderma gangrenosum, Sweet's syndrome, and pustular vasculitis developed in a 60-year-old patient with rheumatoid arthritis over an 8-year period. Over the past 2 years, 3 episodes of peripheral ulcerative keratitis occurred. Cyclosporine (4 mg/kg/d) treatment was started on confirmation of pyoderma gangrenosum. Over the ensuing 2 years, it became evident that the activity of her ocular and skin diseases, as well as her arthritis, paralleled the administration or cessation of cyclosporine therapy. Dermatologists should be aware of the association of Sweet's syndrome, pyoderma gangrenosum, and pustular vasculitis with peripheral ulcerative keratitis. This rare ocular manifestation and the serious sequelae when left untreated make recognition crucial. Cyclosporine proved to be a very effective treatment for all of our patient's diseases.
周边溃疡性角膜炎这一术语代表了一系列炎症性疾病，其特征为细胞浸润、角膜变薄和溃疡形成。嗜中性皮肤病很少与周边溃疡性角膜炎相关。迄今为止，周边溃疡性角膜炎仅在坏疽性脓皮病患者中被报道过。一名60岁的类风湿关节炎患者在8年时间里先后出现了坏疽性脓皮病、Sweet综合征和脓疱性血管炎的不同发作。在过去2年中，该患者发生了3次周边溃疡性角膜炎发作。在确诊坏疽性脓皮病后开始使用环孢素（4mg/kg/天）进行治疗。在随后的2年里，很明显她的眼部和皮肤疾病以及关节炎的活动情况与环孢素治疗的给药或停药情况平行。皮肤科医生应意识到Sweet综合征、坏疽性脓皮病和脓疱性血管炎与周边溃疡性角膜炎之间的关联。这种罕见的眼部表现以及未经治疗时的严重后遗症使得识别至关重要。环孢素被证明对我们这位患者的所有疾病都是一种非常有效的治疗方法。
