Abstract

Volume.122 Number.10

Original article : Case report

A Case of Pediatric Graft-versus-host Disease Accompanied by Pseudomembranous Conjunctivitis that Occurred over 100 Days after Bone Marrow Transplantation
Yuka Yonekawa1, Kumiko Kato1, Yuko Takashima2, Maki Takeuchi1, Mineo Kondo1
1 Department of Ophthalmology, Mie University Graduate School of Medicine
2 Matsusaka Municipal Hospital

Background: Dry eye is the most common known ocular complication of graft-versus-host disease (GVHD) following allogeneic bone marrow transplantation. However, pseudomembranous conjunctivitis is a relatively rare ocular complication of acute GVHD. We report our experience of a pediatric case of GVHD diagnosed because of the onset of pseudomembranous conjunctivitis over 100 days after bone marrow transplantation.
Case: The patient was a 9-year-old girl who underwent treatment at her local clinic for an increase in eye mucus due to bacterial conjunctivitis or allergic conjunctivitis. However, her condition did not improve and she was referred to our department for a closer examination. Formation of a pseudomembrane was observed in the bilateral palpebral conjunctiva and ocular GVHD, and it was suspected based on the fact that the girl had undergone bone marrow transplantation six months earlier. The girl exhibited general malaise, abnormal liver function, and elevated levels of Epstein-Barr virus (EBV) in a blood polymerase chain reaction (PCR) test, which led to a diagnosis of viremia by the department of pediatrics. Therefore, systemic administration of steroids and immunosuppressants was deemed to be difficult. The girl was administered local steroids and tacrolimus and underwent the removal of the pseudomembrane. However, the adhesion of the right upper and lower palpebral conjunctiva progressed and the girl developed a difficulty in opening her eye. After consulting with the department of pediatrics, the systemic administration of prednisolone was added to the girl's treatment regimen, but no improvement was seen. The conjunctival inflammation receded once the systemic administration of tacrolimus was initiated. General malaise and abnormal liver function thought to be caused by viremia subsequently resolved.
Conclusions: We encountered a pediatric case of ocular GVHD, in which the patient presented with pseudomembranous conjunctivitis over 100 days after bone marrow transplantation. Our findings indicated that in cases such as this, where the local administration of is ineffective, the systemic administration of steroids and immunosuppressants should be considered in collaboration with the clinical department that performed the transplantation.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 766-771, 2018.

Key words
Ocular graft-versus-host disease (GVHD), Pseudomembranous conjunctivitis, Symblepharon
Reprint requests to
Kumiko Kato, M.D. Department of Ophthalmology, Mie University Graduate School of Medicine. 2-174 Edobashi, Tsu-shi, Mie-ken 514-8507, Japan