MOOREN-TYPE HEPATITIS-C VIRUS-ASSOCIATED CORNEAL ULCERATION

Background: Two patients with bilateral Mooren-type ulcers had underly ing chronic hepatitis C virus (HCV) infection. Both patients also had chronic, pruritic dermatitis, which in one patient was diagnosed as hi dradentitis suppurativa.Methods: Serum from the first patient and seru m, conjunctiva, and liver from the second patient were analyzed for HC V genomic RNA using the reverse transcriptase-polymerase chain reactio n. Serum anti-HCV antibodies were monitored with a commercially availa ble second-generation test. Liver and conjunctival biopsies were evalu ated histopathologically. Results: Liver biopsy showed severe hepatiti s in the first patient, but normal liver tissue in the second. Hepatit is C virus genomic RNA was detected in the serum of both patients. In the first patient, the virus was detected 4 months after completion of interferon alfa-2b treatment for chronic active hepatitis. In the sec ond patient, HCV genomic RNA was detected in serum, but not in conjunc tiva or liver tissue. Hepatitis C virus could not be detected in the s erum of the second patient after 2 weeks of interferon alfa-2b treatme nt. Both patients had serum anti-HCV antibodies. In case 1, there was a marked improvement in the corneal disease during and after 6 months of interferon alfa-2b treatment for chronic active hepatitis that para lleled a return of serum liver enzyme levels to the normal range. In t he second patient, the corneal disease improved after 6 weeks of inter feron alfa-2b treatment, but abruptly worsened when the patient discon tinued therapy. The corneal disease improved again after interferon al fa-2b was reinstituted. Conclusions: Chronic HCV virus infection is as sociated with Mooren-type peripheral ulcerative keratitis. All patient s with Mooren-type ulcers should be tested for evidence of HCV infecti on in consultation with a liver specialist. Even when improvement is o btained with interferon alfa-2b treatment, however, continued follow-u p is important because relapse is common and repeat treatment may be e ffective.