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J. Unger-Hendee, J.C. Affeldt; Phlyctenular Keratoconjunctivitis and Inflammatory Bowel Disease . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4279.
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Purpose: Phlyctenular keratoconjunctivitis (PKC)represents a delayed hypersensitivity immunologic response to the antigen of an infectious agent. Multiple classes of etiologic agents have been identified, including bacterial, mycobacterial, viral, fungal, chlamydia, protozoa, and parasites. Staphylococcus predominates in the United States. No systemic diseases other than rosacea dermatitis have been associated with this condition. The purpose of this report was to document for the first time a relationship between PKC and the immunologically driven systemic disorder of inflammatory bowel disease (IBD). Methods: Retroactive chart review. Results: Eight patients with corneal changes consistent with PKC (active or inactive) and diagnosed with IBD (via symptomology and/or biopsy) were identified. Mean age was 54. Two patients were male while six were female. HLA-B27 testing was performed on six patients; three were positive and three were negative. Conclusions: Phlyctenular keratoconjunctivitis represents a previously undescribed ocular manifestation of inflammatory bowel disease. The condition manifests primarily in middle aged women, while 50% of affected individuals demonstrate positive HLA-B27 serology. This PKC-IBD association should not be unexpected, given that the disordered immune mechanisms responsible for both PKC and IBD may be one and the same. Class II human leukocyte antigens (HLA) have been associated with both disorders by molecular genotyping and immunohistochemical studies. HLA-B27, a class I HLA, has also been associated with both conditions; the 50% positivity rate for HLA-B27 among tested individuals in this series lends further support for this relationship. Finally, bacterial triggers are implicated in both diseases.
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