Limbal allergic granulomatosis

Topical Steroids in the Management of Churg-Strauss Syndrome Involving the Conjunctiva

PURPOSE

To discuss a case of Churg-Strauss syndrome that developed bilateral conjunctival involvement while recovering from miliary tuberculosis.

METHODS

Case report and literature review.

RESULTS

A 22-year-old man who was on oral prednisolone for Churg-Strauss syndrome since 2002 contracted miliary tuberculosis in June 2004. The diagnosis was confirmed by liver biopsy. Ophthalmologic examination was within reference limits except for bilateral multifocal choroiditis. A combined therapy of rifampicin, ethambutol, streptomycin, and morphazinamide was started on June 24, 2004. Complete recovery was achieved, and the antituberculosis therapy was terminated in June 2005. The patient noted redness and pain in both eyes a month later. He had bilateral irregular, pink-yellow, gravel-like infiltrations involving the bulbar conjunctiva. Biopsy revealed granulomas with central fibrinoid necrosis, histiocytes, and eosinophils, suggestive of conjunctival involvement of Churg-Strauss syndrome. Topical dexamethasone 0.1% drops were started 4 times per day and tapered gradually. Lesions totally regressed within 2 months. No recurrence was noted during a follow-up of 11 months.

CONCLUSIONS

Churg-Strauss syndrome may rarely involve the conjunctiva, and conjunctival lesions respond favorably to topical steroids.

Branch retinal vein occlusion in Churg-Strauss syndrome

The case is reported of a 64-year-old man who was diagnosed as having Churg-Strauss syndrome associated with branch retinal vein occlusion, without accompanying retinal vasculitis. It was assumed that the blood thrombocytosis caused a hypercoagulable state and thromboembolism leading to the branch retinal vein occlusion.

Epibulbar allergic granulomatous nodules in a human immunodeficiency virus-positive patient

PURPOSE

To report an unusual epibulbar inflammatory process in a patient with human immunodeficiency virus (HIV).

METHODS

Case report. A 32-year-old man developed fleshy epibulbar nodules on his right conjunctiva and cornea after being treated for conjunctivitis. A biopsy of the lesions was done, and the specimen was processed for histopathologic examination.

RESULTS

The biopsy specimen contained inflammatory cells, including an eosinophilic abscess. The diagnosis was allergic granulomatous nodules.

CONCLUSION

This case illustrates the occurrence of epibulbar allergic granulomatous nodules in an HIV-positive patient.