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JAMA Ophthalmology Clinical Challenge
June 2013

Conjunctivitis, Fever, and Tender Skin Nodules—Quiz Case

Author Affiliations


Author Affiliations: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary (Drs Palioura and Chodosh) and Department of Pathology, Massachusetts General Hospital (Dr Piris), Harvard Medical School, Boston.

JAMA Ophthalmol. 2013;131(6):791. doi:10.1001/jamaophthalmol.2013.4495a

A 68-year-old man came to the emergency department with a 4-day history of abrupt-onset fever, maculopapular skin rash, bilateral eyelid pain, redness, and discharge. His medical history was significant for ulcerative colitis, which was treated with mesalamine and azathioprine. He experienced an ulcerative colitis flare 2 months prior to presentation that required a high dose of prednisone. His visual acuity was 20/30 OU. Ocular examination revealed tender, erythematous, and edematous eyelids bilaterally with eyelid margin ulcerations, subconjunctival hemorrhages, and mucoid discharge (Figure 1). His corneas were clear and no intraocular inflammation was noted. The remainder of findings from the ocular examination, including funduscopic examination, were unremarkable. Tender skin nodules were noted on his forearms, neck, and abdomen (Figure 2A). Over the next 2 days, the patient remained febrile and the skin nodules became pustules (Figure 2B). His eyes remained inflamed despite use of topical steroid and antibiotic ointment.

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