Chakraborty Chandana, Sarkar Kumaresh C, Majumdar Swati, Chaudhury Krittika P
Department of Ophthalmology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India.
Oman J Ophthalmol. 2012 May;5(2):106-8. doi: 10.4103/0974-620X.99374.
A 63-year-old man with unremarkable previous ocular history presented with bilateral symmetrical corneal ulceration along with mucopurulent conjunctivitis and dry eye 10 days after the fourth dose of intravesical Bacille Calmette-Guerin (BCG) instillation for treatment of bladder carcinoma. Slit lamp examination revealed thinning of the cornea at the base of the ulcer in both eyes. Conjunctival swab and scraping from ulcer sent for Gram and acid fast bacilli stain and culture were negative. On the basis of history, clinical examination, and laboratory investigations, we diagnosed it as bilateral immune mediated sterile corneal ulceration along with mucopurulent conjunctivitis and dry eye. He was treated with topical antibiotics, cycloplegics, cyclosporine, lubricant gel, and bandage contact lens. There was progressive stromal melting, descemetocele formation, and perforation in the inferior part of cornea in both the eyes. He was treated with pulse steroid and paramedian tarsorraphy in both eyes. The patient was subsequently lost to follow-up. We report this case to highlight this rare complication of BCG therapy, in order to improve their management protocol in patients with similar clinical profile. We could not find a similar case after thorough PubMed search.
一名63岁男性，既往眼部病史无异常，在膀胱灌注卡介苗（BCG）第四剂用于治疗膀胱癌10天后，出现双侧对称性角膜溃疡，伴有黏液脓性结膜炎和干眼。裂隙灯检查显示双眼溃疡底部角膜变薄。结膜拭子和溃疡刮片送检革兰氏和抗酸杆菌染色及培养均为阴性。根据病史、临床检查和实验室检查，我们诊断为双侧免疫介导的无菌性角膜溃疡伴黏液脓性结膜炎和干眼。给予局部抗生素、睫状肌麻痹剂、环孢素、润滑凝胶和绷带式隐形眼镜治疗。双眼角膜基质逐渐溶解，后弹力层膨出形成，并在角膜下部穿孔。双眼给予脉冲类固醇和睑裂缝合术治疗。该患者随后失访。我们报告此病例以突出BCG治疗的这种罕见并发症，以便改善具有相似临床特征患者的管理方案。经全面的PubMed搜索，我们未发现类似病例。
