Bilateral interstitial keratitis with anterior stromal infiltrates associated with reactive arthritis

Abstract

A previously healthy 48-year-old man presented with a 1-week history of migrating polyarthropathy preceded by a viral illness, dysuria and bilateral red eyes. Ocular examination revealed anterior and interstitial stromal keratitis. He was systemically well but had raised erythrocyte sedimentation rate and C reactive protein and was positive for human leucocyte antigen B27 on extensive infective, rheumatological and autoimmune investigations. Although the exact triggering pathogen was not identified, clinical findings were consistent with reactive arthritis. Bilateral interstitial keratitis is a rare manifestation of reactive arthritis which, along with the anterior stromal keratitis, responded well to topical prednisolone sodium phosphate 0.5%. Systemic joint symptoms improved on oral sulfasalazine, non-steroid anti-inflammatory agent and low-dose prednisolone.

Keywords: ophthalmology; rheumatology.

Figure 1

Patient with swollen joints in fingers and hand (left greater than right).

Figure 2

Focal anterior corneal stromal infiltrates (right eye). Similar appearance was seen in the left eye.

Figure 3

Diffuse interstitial corneal stromal infiltrates (right eye). Similar appearance was seen in the left eye.