Treatment of ligneous conjunctivitis with heterologous serum

Delayed-onset ligneous conjunctivitis as a rare association with congenital hydrocephalous: a case report and review of the literature

Ligneous conjunctivitis is an uncommon form of chronic and recurrent conjunctivitis characterized by a thick, "woody," yellowish pseudomembranous lesion on the tarsal conjunctiva. Plasminogen deficiency plays an important role in this disease, which affects the mucous membranes, including the conjunctiva as well as other systemic organs. In rare cases, congenital hydrocephalus is associated with this disease. We present the case of a 21-year-old woman with delayed-onset bilateral ligneous conjunctivitis and a history of congenital hydrocephalous in infancy. She was treated with topical ophthalmic medication and surgical excision.

[Pharmaceutical supply of human plasminogen replacement therapy for the treatment of ligneous conjunctivitis: Logistics for a university hospital]

In order to treat a pediatric patient with ligneous conjunctivitis secondary to congenital plasminogen deficiency, a supply of topically administered replacement human plasminogen has been required. In the absence of market approval, this blood-derived drug is managed by a temporary authorisation for nominative use, allowing monthly hospital dispensations. To ensure regulatory compliance and proper use of the drug, it took two years of interactions between various hospital departments and the laboratory to define the pharmaceutical supply chain in our hospital and allow the patient to receive treatment. The main difficulties lie in respecting the cold chain of this drug stored frozen in the bottles not ready for use. Transportation from the laboratory to the patient's home via the hospital pharmacy is carried out in calibrated conditions, ensuring a temperature below -20°C for 72h. Reception and dispensing steps were combined into a single pharmaceutical service in order to optimise transport time while ensuring the safety and traceability of the drug lots. Each month, a date is scheduled between the hospital pharmacy, the laboratory and the family to ensure that delivery and dispensing take place on the same day. Appropriate use and handling are explained to the family. However, two issues remain to be addressed by the manufacturer to facilitate future use of human plasminogen: the thermostability problem, which does not allow stays away from home longer than three days, and self-administration by the child, which is unlikely to be feasible due to handling difficulties.