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P. Lim, J.C. Affeldt; Simultaneous Phlyctenular Keratoconjunctivitis and Marginal Staphylococcal Keratitis in Inflammatory Bowel Disease . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2633.
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Purpose: Phlyctenular keratoconjunctivitis (PKC) represents a cell mediated type IV hypersensitivity immune response to the antigen of an infectious agent. Multiple classes of etiologic agents have been identified, but most cases in the United States are associated with staphylococcal blepharitis. Marginal staphylococcal Keratitis (MSK) is a related entity that represents a humoral antigen–antibody immune response to a bacterial antigen, again usually staphylococci. The purpose of this report is to document for the first time the phenomena of simultaneous PKC and MSK in a patient with inflammatory bowel disease (IBD). Methods: Observational case report Results: A patient diagnosed with IBD was found to have corneal changes consistent with both PKC (wedge–shaped centrally apexed peripheral corneal scars with pannus emanating from the limbus) and MSK (perilimbal ovally elongated superficial peripheral corneal scars with intervening clear stroma). Conclusions: Simultaneous PKC and MSK represents a previously undescribed ocular manifestation of IBD. PKC and MSK involve cell mediated and humoral immunity, respectively, and both types of immunity are implicated in the pathogenesis of IBD. Therefore, it is not surprising that both PKC and MSK can coexist in patients with IBD, given that the disordered immune mechanism responsible for all three conditions may be one and the same. Likewise, bacterial triggers are implicated in all three entities. Thus, PKC and MSK, particularly in combination, may serve as external (ocular) markers for suspicion and diagnosis of IBD.
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