Objectives: To describe an unusual case of ocular mucous membrane pemphigoid ( OcMMP ) with bilateral ocular involvement in association with Graves’ disease( GD) and ankylosing spondylitis ( AS ).
Patients and Methods: A case report.
Results: The patient suffered persistent bilateral ocular inflammation, protopsis, and decreased visual acuity for the past 2 years, with a history of GD and AS and recurrent vesiculobullous lesions on the trunk, genital, buccal mucosa and palate. A biopsy specimen obtained from the vesiculobullous lesion showed subepidermal bulla containing neutrophils and eosinophils. But direct immunofluorescence of IgG and C3 and circulating autoantibodies were both negative. Because typical clinical characteristics were evident, a diagnosis of mucous membrane pemphigoid was made. The skin lesions were controlled with intravenous methylprednisolone and prednisone. But Conjunctivitis and corneal neovacularization increased and both eyes showed conjunctival hyperaemia, scar of the tarsal conjunctiva with symblepharon formation, pseudomembrane covering extensive areas of the left eye surface. This condition had progressed until total blindness. Infliximab etanercept and methotrexate were also administered during this period.
Conclusion: The association among Mucous membrane pemphigoid, AS and GD is unlikely to be unique and may reflect some underlying immunogenetic susceptibility to autoimmune disease.