97th DOG Annual Meeting 1999
LIGNEOUS CONJUNKTIVITIS IN SEVERE TYP I PLASMINOGEN
J. Kraft1, P. Zeitler2, V. Schuster2, W. Waller1
Ligneous conjunctivitis is a rare bilateral chronic conjunctivitis with recurrent pseudomembranes. It is most common in children and may be associated with similiar lesions affecting other mucous membranes, e.g. the respiratory tract. A current progress in description of ligneous conjunctivitis has not been matched by better understanding of the etiology. Defects in coagulation system, e.g. fibrinolysis are discussed.
Case report: A 9 month old Turkish girl was presented with a massive swelling of the lids and white wooden pseudomembranes on both eyelids. A removal of the membranes resulted in bleeding and regrowing of the membrane. The conjunctival smear was positive for Streptococcus pneumoniae. The clinical diagnosis was: ligneous conjunctivitis with superinfection. The coagulation analysis showed an significant decreased level of plasminogen (3.2%) and a reduction of 50% in plasminogen activity. Genetic investigations were suspicious of a inherited homozygote deficiency of plasminogen.The parents were both heterozygote. The fast progression of the membranes in our case necessitated a membrane excision and further treatment with topical heparin. The initial improvement of the symptoms was again followed by a deterioration after 2 months. As an experimental attempt in therapy an intravenous application of Lys-Plasminogen was done, beginning with 300 CU in increasing dosage till 3000 CU. Under increasing of the dosis a significant improvement of the ocular symptoms occured, but after reduction pseudomembranes regrew fastly.
Discussion: The initial improvement of the symptoms of this severe case of an ligneous conjunctivitis after systemic application of plasminogen is to be seen as an evidence of the etiological importance of the deficiency of plasminogen.
Conclusion: The etiology of the ligneous conjunctivitis is still not completely understood. An important factor may be the deficiency of plasminogen. Therefore a coagulation analysis with determinaton of the plasminogen level has to be done in each case. The intravenous application of plasminogen offers new possibilities in therapy, but a long term treatment seems to be necessary.
Department of Ophthalmology1 and Pediatrics2, Julius-Maximilian-University, D-97080 Würzburg