OBJECTIVE

To describe the first biopsy-proven case of ocular cicatricial pemphigoid (OCP) in a young, Filipino male – an atypical presentation for this disease.

METHODS

This is a case report.

CASE PRESENTATION

A 34-year-old healthy Filipino male presented with a 2-year history of intermittent eye redness, foreign body sensation, and tearing. Slit lamp examination revealed symblepharon formation and fornix shortening of both eyes. Excision of symblepharon with ocular surface reconstruction using amniotic membrane graft was performed, and the conjunctival specimen was sent for immunohistochemical analysis. Direct immunofluorescence was performed which confirmed strong linear deposits of IgG and fibrinogen along the basement membrane zone, confirming diagnosis of OCP. Early diagnosis and prompt treatment is even more important in the younger population as OCP tends to progress more rapidly, and is associated with more severe manifestations. If left untreated, OCP may progress to symblepharon or, in severe cases, ankyloblepharon formation.

CONCLUSION

OCP is a rare, sight-threatening, chronic, autoimmune disease that involves inflammation and cicatrization of the conjunctiva, which typically affects older females and is rarely seen in younger populations. This case report highlights the need for increased awareness among clinicians in the Philippines to consider OCP as a differential diagnosis for chronic conjunctivitis, even in patients outside the typical demographic. Early recognition and confirmatory biopsy are essential to prevent progressive ocular surface scarring and vision-threatening complications.

Human ; Male ; Adult: 25-44 Yrs Old ; Pemphigoid, Benign Mucous Membrane ; Ocular Cicatricial Pemphigoid ; Pemphigoid, Bullous ; Philippines

Introduction: Zinc deficiency is of high magnitude in developing countries such as the Philippines. Zinc deficiency dermatitis is recognized through characteristic cutaneous presentation supported by diagnostic workups which may not be feasible or practical in low-resource settings. Case report: A three-month-old Filipino male was brought in for erosions of three (3) weeks duration that were unrespon- sive to topical and systemic antimicrobial treatment. On examination, he had multiple erythematous erosions with yellowish to brownish, crusted borders with predilection on the face, inguinal and gluteal areas, flexures of the extremities, and digits. Workup revealed normal zinc levels, decreased alkaline phosphatase, and bacterial growth in cultures. Histopathology revealed intraepidermal vesiculobullous dermatitis. Given the clinicopathologic presentation, a diagnosis of zinc deficiency-associated dermatitis was made. Along with antimicrobials and topical care, oral zinc sulfate with elemental zinc at 3 mg/kg/day was started, with remarkable improvement within three (3) days and near-resolution after eight (8) days of zinc therapy. Zinc supplementation was administered for three (3) months with gradual tapering. The skin remained clear despite the withdrawal of zinc supplemen- tation. Response to treatment supported the impression of zinc deficiency, while sustained skin clearance upon withdrawal verified an acquired etiology. Conclusion Zinc deficiency-associated dermatitis is more common in areas where costly diagnostic modalities are not readily available. In clinically suspected zinc deficiency, response to treatment can serve as a retrospective diagnostic feature, and sus- tained clearance upon withdrawal may aid in identifying etiology. Trial of therapy may then be considered in optimizing the cost-ef- fective management of zinc deficiency-associated dermatitis.
Malnutrition