What is your approach to immunosuppression in patients with recurrent peripheral ulcerative keratitis or marginal keratitis who have active disease despite steroid therapy and no current evidence of rheumatologic disease?
Is the approach different from uveitis immunosuppression?
Answer from: at Academic Institution
Drs. @Koreishi and @Rosenbaum provide some excellent insight in their responses. In this question, it's stated the patient has active disease despite steroids. I would agree with both Drs. @Koreishi and @Rosenbaum that non-infectious PUK typically requires high-dose steroid (1mg/kg) at the onset to ...
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Answer from: at Community Practice
This is a good question and something that can eventually be frustrating to treat if your initial few therapies aren’t enough. First, I want to distinguish between peripheral ulcerative keratitis and what you may be referring to as staph marginal? Staph marginal are small peripheral ulceration...
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at University of California, Berkeley and San Francisco
Don't forget Sjogren's in underlying Ddx of cornea...
Don't forget Sjogren's in underlying Ddx of cornea...
Answer from: at Community Practice
The terms peripheral ulcerative keratitis (PUK), marginal keratolysis, and corneal melt are all roughly equivalent. As Dr. @Koreishi wrote, it is important to exclude other conditions. Occasionally herpes simplex infection could mimic this. Mooren's ulcer and Terrien's marginal degeneration are also...
Answer from: at Community Practice
I agree with both my colleagues that there can be a "prozone" effect with the ANCA such that false negative results occur and antibodies to PR-3 or MPO are detectable. The disagreement is with the word "screening". I screen with the ANCA and request antibodies to MPO and PR-3 in circumstances in whi...