Uner Ogul E, Pegany Roma B, Stiefel Hillary C, Stutzman Richard D, Redd Travis K
Casey Eye Institute, Oregon Health & Science University, 515 SW Campus Dr, Portland, OR, USA.
Department of Ophthalmology, University of California, San Francisco, 490 Illinois St, San Francisco, CA, USA.
Am J Ophthalmol Case Rep. 2024 Oct 3;36:102178. doi: 10.1016/j.ajoc.2024.102178. eCollection 2024 Dec.
We describe a case of metastatic conjunctival squamous cell carcinoma (SCC) presenting as an infectious sclerokeratouveitis in a patient with autoimmune disease.
A 63-year-old Caucasian female presented to the cornea service with a raised perilimbal scleral infiltrate, hypopyon, and corneal perforation concerning for infectious necrotizing sclerokeratoveitis. She had an ocular history of a recurrent "pyogenic granuloma" and her medical history was notable for well-controlled systemic lupus erythematosus and rheumatoid arthritis. Scleral debridement and repair with a corneal patch graft was performed. Bacterial cultures grew 4+ sensitive to tobramycin. One month later, she developed bulky painless scleral lesions with leukoplakic features. A scleral biopsy revealed squamous cell carcinoma. Imaging suggested ciliary body and medial rectus infiltration without perineural invasion. Right anterior exenteration was performed as immunotherapy was felt to be unlikely to achieve success in light of her autoimmune conditions. Six months later, she developed a palpable right parotid mass with biopsy confirming metastatic squamous cell carcinoma. She underwent a right parotidectomy and is now undergoing consolidative radiotherapy.
Ocular surface neoplasia can present as a necrotizing sclerokeratouveitis, contributed by both the tumor and an atypical infectious process. Malignancy with superinfection should be in the differential diagnosis of recurrent ocular surface inflammation.
我们描述了一例转移性结膜鳞状细胞癌（SCC），该病例表现为一名自身免疫性疾病患者的感染性巩膜角膜葡萄膜炎。
一名63岁的白人女性因角膜缘巩膜浸润隆起、前房积脓和角膜穿孔就诊于角膜科，怀疑为感染性坏死性巩膜角膜葡萄膜炎。她有复发性“化脓性肉芽肿”的眼部病史，其病史以系统性红斑狼疮和类风湿关节炎控制良好为显著特点。进行了巩膜清创术并使用角膜补片移植进行修复。细菌培养结果显示对妥布霉素4+敏感。一个月后，她出现了具有白斑特征的巨大无痛性巩膜病变。巩膜活检显示为鳞状细胞癌。影像学检查提示睫状体和内直肌浸润，但无神经周围侵犯。鉴于她的自身免疫状况，认为免疫治疗不太可能成功，于是进行了右眼眼球摘除术。六个月后，她出现了可触及的右侧腮腺肿块，活检证实为转移性鳞状细胞癌。她接受了右侧腮腺切除术，目前正在接受巩固性放疗。
眼表肿瘤可表现为坏死性巩膜角膜葡萄膜炎，这是由肿瘤和非典型感染过程共同导致的。恶性肿瘤合并二重感染应列入复发性眼表炎症的鉴别诊断。
