Abstract：
Ligneous conjunctivitis is a very rare form of pseudomembranous conjunctivitis with few published cases in literature. We aim to describe the ocular findings and treatment in an infant with ligneous conjunctivitis resembling preseptal cellulitis on presentation.
Case report of a 3-month-old girl who was referred to a tertiary centre for ophthalmic assessment due to progressive eyelid oedema with no response to initiated topical and systemic antibiotics. Ethical approval has been achieved from the local ethics committee of the Ghent University Hospital and informed consent has been obtained from the parents of the child.
Examination under general anaesthesia showed multiple, wood-like fibrinous pseudomembranes, originating from the conjunctiva, consistent with ligneous conjunctivitis. After careful removal of the coagulated exudate covering the cornea, a central corneal epithelial defect was evident without stromal infiltration. Histopathologic examination confirmed the predominance of fibrin within the pseudomembranes. Plasminogen activity was below the normal range. Genetic analysis did not identify a pathogenic variant in the PLG gene. The corneal epithelium re-epithelialised during the following days and the conjunctival lesions gradually subsided over the ensuing weeks whilst continuing heparin-containing artificial tears.
A high level of suspicion is warranted in atypical cases of preseptal cellulitis which show no response to antibiotic treatment. Particularly in young children, examination under general anesthesia is warranted to allow diagnosis of rare causes of secondary eyelid oedema. We report an infant with unilateral ligneous conjunctivitis who responded well to topical, commercially-available heparin-containing artificial tears treatment. This approach is an effective and easy first-line treatment option in this condition, particularly in milder phenotypes.
Case report of a 3-month-old girl who was referred to a tertiary centre for ophthalmic assessment due to progressive eyelid oedema with no response to initiated topical and systemic antibiotics. Ethical approval has been achieved from the local ethics committee of the Ghent University Hospital and informed consent has been obtained from the parents of the child.
Examination under general anaesthesia showed multiple, wood-like fibrinous pseudomembranes, originating from the conjunctiva, consistent with ligneous conjunctivitis. After careful removal of the coagulated exudate covering the cornea, a central corneal epithelial defect was evident without stromal infiltration. Histopathologic examination confirmed the predominance of fibrin within the pseudomembranes. Plasminogen activity was below the normal range. Genetic analysis did not identify a pathogenic variant in the PLG gene. The corneal epithelium re-epithelialised during the following days and the conjunctival lesions gradually subsided over the ensuing weeks whilst continuing heparin-containing artificial tears.
A high level of suspicion is warranted in atypical cases of preseptal cellulitis which show no response to antibiotic treatment. Particularly in young children, examination under general anesthesia is warranted to allow diagnosis of rare causes of secondary eyelid oedema. We report an infant with unilateral ligneous conjunctivitis who responded well to topical, commercially-available heparin-containing artificial tears treatment. This approach is an effective and easy first-line treatment option in this condition, particularly in milder phenotypes.
摘要：
网状结膜炎是一种非常罕见的伪膜性结膜炎，文献中很少发表病例。我们的目的是描述患有网状结膜炎的婴儿的眼部表现和治疗，其表现类似于脑前蜂窝织炎。
一名3个月大的女孩因进行性眼睑水肿而转诊至三级中心进行眼科评估的病例报告，对开始的局部和全身抗生素无反应。根特大学医院当地伦理委员会已获得伦理批准，并获得了孩子父母的知情同意。
全身麻醉检查显示多次，木样纤维假膜，起源于结膜，符合木质性结膜炎。小心去除覆盖角膜的凝结渗出物后，中央角膜上皮缺损明显，无基质浸润。组织病理学检查证实假膜内纤维蛋白占优势。纤溶酶原活性低于正常范围。遗传分析未鉴定出PLG基因中的致病变体。在接下来的几天中，角膜上皮重新上皮化，结膜病变在随后的几周内逐渐消退，同时继续使用含肝素的人工泪液。
在不典型的对抗生素治疗无反应的脑前蜂窝织炎病例中，需要高度怀疑。特别是在年幼的孩子中，必须在全身麻醉下进行检查，以诊断继发性眼睑水肿的罕见原因。我们报告了一名患有单侧结膜炎的婴儿，他对局部反应良好，市售的含肝素的人工泪液治疗。在这种情况下，这种方法是一种有效且简单的一线治疗选择，特别是在较温和的表型中。
一名3个月大的女孩因进行性眼睑水肿而转诊至三级中心进行眼科评估的病例报告，对开始的局部和全身抗生素无反应。
全身麻醉检查显示多次，
在不典型的对抗生素治疗无反应的脑前蜂窝织炎病例中，需要高度怀疑。
