School of Medicine (R.S.G.), University of Maryland, Baltimore, MD; and Department of Ophthalmology and Visual Sciences (A.R.E., W.M.M.), University of Maryland, Baltimore, MD.
Eye Contact Lens. 2023 Dec 1;49(12):572-574. doi: 10.1097/ICL.0000000000001042. Epub 2023 Sep 20.
This report highlights a postinfectious mucocutaneous inflammatory response involving the ocular surface and adnexa after Chlamydophila psittaci exposure.
A 35-year-old man presented after a prodrome of upper respiratory symptoms with rash and mucocutaneous blistering involving the ocular and oral mucosa, causing pseudomembranous conjunctivitis and corneal epithelial defects. Extensive inflammatory and infectious workup suggested recent C. psittaci infection. The patient was treated with doxycycline and supportive therapy, whereas the ocular surface was treated with lubrication and prophylactic antibiotics. In follow-up, he has retained excellent visual acuity but required scleral contact lenses to control ocular surface symptoms because of fibrotic changes of the marginal conjunctiva.
Such blistering inflammation has most commonly been described after pediatric respiratory infections because of Mycoplasma pneumoniae with additional instances related to Chlamydia pneumoniae , Epstein-Barr virus, influenza B, and other stimuli . To the best of our knowledge, this is the first reported case of C. psittaci- induced reactive infectious mucocutaneous eruption (RIME). RIME is a rare parainfectious inflammatory condition with sequelae frequently involving the periocular mucosa. Although systemic and nonocular adverse outcomes in this condition tend to be self-limited, the impact on the ocular surface may be severe, and the consequences to vision may be ongoing, especially if not treated aggressively at the outset.
本报告强调了鹦鹉热衣原体暴露后涉及眼表面和附属器的感染后黏膜炎症反应。
一名 35 岁男性在上呼吸道症状前驱期后出现皮疹和黏膜水疱，累及眼部和口腔黏膜，导致伪膜性结膜炎和角膜上皮缺损。广泛的炎症和感染性检查提示近期鹦鹉热衣原体感染。患者接受多西环素和支持治疗，同时使用润滑剂和预防性抗生素治疗眼表面。随访时，他保持了良好的视力，但由于边缘性结膜炎的纤维化改变，需要巩膜接触镜来控制眼表面症状。
这种水疱性炎症最常发生在儿童呼吸道感染后的肺炎支原体感染后，另有一些与肺炎衣原体、EB 病毒、乙型流感和其他刺激因素有关的病例。据我们所知，这是首例由鹦鹉热衣原体引起的反应性感染性黏膜皮肤疹（RIME）报告。RIME 是一种罕见的副感染性炎症性疾病，后遗症常累及眶周黏膜。尽管这种情况下的全身和非眼部不良结局往往是自限性的，但对眼表面的影响可能很严重，而且如果一开始不积极治疗，对视力的影响可能持续存在，尤其是如果不积极治疗的话。
