A 58-year-old woman diagnosed with rheumatoid arthritis (RA) and nodular erosive arthritis with high rheumatoid factor titers of 15 years of evolution.
He had received previous treatment with different disease-modifying antirheumatic drugs (DMARDs): hydroxychloroquine, cholinease, cyclosporine and lefluid, removed for ineffective.
She was still under treatment with methotrexate 25mg/week complete remission without prednisone 5-10mg/day variable and infliximab 5mg/kg/IV/8 weeks with acceptable control of the disease in the last 2 years
She developed septic arthritis of the right ankle with synovial fluid culture positive for Staphylococcus aureus.
Infliximab was removed and treatment with intravenous antibiotics was started.
At 3 months she consulted for red eye, severe periorbital pain and photophobia.
The patient had an upper peripheral corneal infiltrate in a semiluna with extreme stromal thinning associated with scleritis.
Culture of the corneal scraping was negative.
The suspicion of severe QUP is initiated with prednisone 1mg/kg/day orally without response.
Megadoses of methylprednisolone 1g/IV/3 days were prescribed.
In addition, surgical resection of the conjunctival tissue adjacent to the QUP and cyanoacrylate adhesive were performed to prevent ocular perforation.
The patient responded poorly to treatment, with persistent pain, scleritis and corneal infiltrate.
As there was also no optimal control of the underlying disease, we started infusion of rituximab 1g/i.v. two infusions separated by 15 days.
Three weeks after the beginning of the treatment a significant clinical improvement was observed, presenting corneal leukoma of inactive aspect without scleritis.
She is currently receiving i.v. rituximab treatment for RA every 8 months with good clinical control.
