Chronic bilateral multifocal superficial keratitis in a pediatric patient.
Chronic bilateral multifocal superficial keratitis in a pediatric patient.
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DOI：
10.1016/j.ajoc.2022.101495
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发表时间：
2022-06
影响因子：
--
通讯作者：
Yu CQ
中科院分区：
文献类型：
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作者：
Vieira IV;Fan VH;Duan C;Yu CQ
2.讨论儿童角膜炎的鉴别诊断包括先天性疾病、外伤、维生素A缺乏、全身药物沉积、特应性或感染性疾病。1我们的患者没有任何先天性或全身性疾病，除了角膜病变外，完全健康。她没有服用任何系统性药物。感染性原因，如葡萄球菌和肺炎球菌性角膜结膜炎或疱疹性角膜炎，由于病变的慢性双侧表现和外观，不是可能的原因。这些病变是浅表性的，也不符合常见的病毒相关疾病，如腺病毒后上皮下浸润或爱泼斯坦巴尔病毒钱币状角膜炎。考虑干眼病导致角膜炎，但与检查结果和年龄组不一致。Thygeson浅层角膜炎是一种病因不明的双侧角膜炎，导致点状浅层病变，对类固醇治疗反应迅速。我们的病例的特征与Thygeson角膜炎相似，有恐光症的症状，眼睑间区域有小的不透明和隆起的病变，结膜外观平静，类固醇治疗后迅速消退。（2）Thygeson病例中未见线状病变和旋涡样改变。3飓风和旋涡性角膜病变可以有线性外观，但没有注意到有表面线性白色病变。结论我们在此提出一个非常独特的外观，但病因不明，我们还没有看到以前发表的双侧浅表性角膜炎。根据我们对该病例的经验，它似乎与Thygeson病有一些相似之处，短期局部类固醇治疗可以有效地治疗这种情况。
2. DiscussionThe differential diagnosis of keratitis in children includes congenital conditions, trauma, vitamin A deficiency, deposits of systemic medication, atopy, or infectious diseases. 1 Our patient did not have any congenital or systemic condition, being completely healthy except for the corneal lesions. She was not on any systemic medication. Infectious causes, such as staphylococcal and pneumococcal keratoconjunctivitis or herpes keratitis, were not a probable cause due to the chronic bilateral presentation and appearance of the lesions. These lesions, being superficial, also did not appear consistent with common virus-related conditions, such as post adenoviral subepithelial infiltrates or Epstein Barr Virus nummular keratitis. A dry eye condition resulting in filamentary keratitis was considered but not consistent with exam and age group. Thygeson's superficial keratitis is a bilateral keratitis of unclear etiology which results in punctate superficial lesions and responds quickly to steroid treatment. Characteristics of our case that are similar to Thygeson's keratitis are the symptoms of photophobia, the presence of small opaque and elevated lesions concentrated in the interpalpebral region, quiet conjunctival appearance, and the fast resolution with steroid therapy. 2 However, linear lesions and vortex pattern are not mentioned in Thygeson's cases. 3 Hurricane and vortex keratopathies can have a linear appearance but are not noted to have superficial linear white lesions.3. ConclusionWe here present a bilateral superficial keratitis of very distinctive appearance but unclear etiology that we have not seen previously published. Given our experience with this case, it appears to have some similarity with Thygeson's disease, and a short course of topical steroid therapy can be used to treat this condition effectively.