Clinical findings and management of conjunctival intraepithelial neoplasia

Resolution of Plaque Keratopathy in a Patient with Atopic Keratoconjunctivitis After Treatment with Leflunomide

PURPOSE

To report a case of resolution of corneal findings in a patient with atopic keratoconjunctivitis after treatment with leflunomide.

METHODS

Case report.

RESULTS

A 57-year-old male presented with ocular signs and symptoms consistent with severe atopic keratoconjunctivitis. His case was distinguished by impressive sub-epithelial Salzmann-like nodules in the shape of petaloid plaques in both eyes. These keratinized plaques persisted despite topical steroids, tacrolimus ointment, and routine subconjunctival triamcinolone injections. The patient was started on leflunomide 10 mg daily for seropositive rheumatoid arthritis with rapid subsequent improvement in his symptoms, vision, and keratopathy. The patient has remained stable on oral leflunomide.

CONCLUSION

To the authors' knowledge, this is the first case report to describe rapid resolution of "plaque keratopathy" and improvement of AKC with leflunomide treatment. Further work remains to be done to elucidate the role of disease-modifying drugs in atopic keratoconjunctivitis.