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Impressum
Filiform Keratitis and Sjögren`s Syndrome in a patient with Hashimoto`s Thyroiditis and Pernicious Anemia
Löblich R., Mittelviefhaus H.
Augenklinik, Univerisität Freiburg
Introduction: We report on a 64 year-old woman, who presented
with severe drye eye syndrome not improving under local treatment.
Case Report: In 1993 the patient developed hypothyreoidism after
Hashimoto`s thyroiditis followed by pernicious anemia in 1995. Since 1996
she suffered from progressive dry eye syndrome with supraorbital, pressurelike
headache and from xerostomie. The clinical investigation showed an elevated
frequency of blinking, bilateral conjunctival irritation with filiform
keratitis, Schirmer tests (I) of 0 mm and a tear brake up time < 5
sec. Antimicrosomal antibodies suggested a chronic lymphocytic form of
Hashimoto`s thyroiditis and partial cell antibodies a pernicious anemia.
Furthermore the CD3 and CD20 positiv lymphocytic infiltration of the lacrimal
and minor salivary glands is compatible with a Sjögren`s syndrome.
Discussion: The association of Sjögren`s syndrome, Hashimoto`s
thyroiditis and pernicious anemia is extremly rare and suggests a general
dysfunction of immunoregulation. This general dysfunction explains the
simultaneous clinical manifestation of different autoimmuno diseases as
well as the lack of improvement of the filiform keratoconjunctivitis under
local treatment. Therefore a systemic immunsuppressive therapy is necessary.
Löblich R., Mittelviefhaus H.
Augenklinik, Univerisität Freiburg
Introduction: We report on a 64 year-old woman, who presented
with severe drye eye syndrome not improving under local treatment.
Case Report: In 1993 the patient developed hypothyreoidism after
Hashimoto`s thyroiditis followed by pernicious anemia in 1995. Since 1996
she suffered from progressive dry eye syndrome with supraorbital, pressurelike
headache and from xerostomie. The clinical investigation showed an elevated
frequency of blinking, bilateral conjunctival irritation with filiform
keratitis, Schirmer tests (I) of 0 mm and a tear brake up time < 5
sec. Antimicrosomal antibodies suggested a chronic lymphocytic form of
Hashimoto`s thyroiditis and partial cell antibodies a pernicious anemia.
Furthermore the CD3 and CD20 positiv lymphocytic infiltration of the lacrimal
and minor salivary glands is compatible with a Sjögren`s syndrome.
Discussion: The association of Sjögren`s syndrome, Hashimoto`s
thyroiditis and pernicious anemia is extremly rare and suggests a general
dysfunction of immunoregulation. This general dysfunction explains the
simultaneous clinical manifestation of different autoimmuno diseases as
well as the lack of improvement of the filiform keratoconjunctivitis under
local treatment. Therefore a systemic immunsuppressive therapy is necessary.