Ligneous conjunctivitis in a patient with Crohn’s disease

OBJECTIVE: Report the case of a patient with Crohn’s disease and ligneous conjunctivitis. METHODS: Interventional case report of a 27-year old female patient, with a 4-year history of Crohn’s disease, was seen for right eye conjunctival ulcer after resolved chemical trauma. Conjunctival biopsy was performed for histopathology, immunofluorescence microscopy, and immunohistochemistry testing. RESULTS: Microbiology tests were negative for bacteria and fungi. PCR was negative for atypical mycobacteria and Herpes. Ocular Crohn’s disease, Whipple disease, and amyloidosis were ruled out. Immunofluorescence microscopy revealed characteristic IgG κ and λ light chain deposits, and fibrin deposition was confirmed through Lendrum’s Martius, Scarlet, and Blue technique. Endogenous plasminogen levels were normal. Recurrent ulcers did not resolve after treatment with infliximab, but only after four surgeries, topical steroids, 1% cyclosporine, heparin (5000 units/ml), and hyaluronidase (1.5 mg/ml). After 9 months of follow-up, nasal symblepharon was observed as sequela. CONCLUSIONS: We report the case of a patient with unilateral ligneous conjunctivitis, triggered by chemical injury, and Crohn’s disease.