Peripheral ulcerative keratitis in Antineutrophil cytoplasmic antibody (ANCA) – associated vasculitis

Abstract

A 61-year-old Thai male, with underlying condition of hypertension and chronic renal failure presented with a low-grade fever for 2 weeks in addition to cough, fatigue, arthralgia, red eye, eye pain, watery discharge and blurred left eye for 1 month. Eye examination revealed mild to moderate injected conjunctiva and deep diffuse sclera with a crescent-shaped stromal inflammation on the limbus edge of cornea 6-12 o’clock with stromal thinning and epithelial defect. Laboratory results showed leukocytosis with neutrophil predominance, ESR and CRP was higher than normal, the cause of infection was not found. Initially, it was treated by intravenous antibiotics for a period of 1 week, the patient continued to have low grade fever every day. Finding the cause of immune fever showed p-ANCA: positive. Ocular treatment consisted of artificial tears, topical antibiotics and topical steroids in combination with systemic treatment by systemic steroid and immunomodulators, so the patient was discharged and followed up at outpatient department.