Effective steroid-sparing treatment for peripheral ulcerative keratitis and pyoderma gangrenosum

Objective. To report a patient with a rare clinical presentation of margina l keratitis and pyoderma gangrenosum (PG) that responded to the steroid-spa ring agent azathioprine. Design. Interventional case report. Methods. Case report and MEDLINE review of the medical literature on PG-associated periph eral ulcerative keratitis (PUK) and its treatment. Results. A patient with a biopsy-proven history of PG developed an explosive episode of PUK. The oc ular inflammation was minimally responsive to topical therapy and required significant long-term oral steroids for control. The patient's active skin lesions and marginal keratitis responded dramatically to systemic oral azat hioprine. Since the initiation of treatment with azathioprine, there have b een no subsequent recurrences of PG or marginal keratitis. Conclusions. PUK may be associated with other inflammatory conditions, such as PG and arthr itis. Systemic azathioprine may successfully control ocular and extraocular conditions and should be considered in the clinical setting of topical the rapy failure and/or extraocular inflammatory conditions.