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JAMA Ophthalmology Clinical Challenge
April 2018

Bulbar Conjunctival Nodule in a Patient With Rheumatoid Arthritis

Author Affiliations
  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • 2Avera Medical Group Ophthalmology, Marshall, Minnesota
  • 3Department of Pathology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. 2018;136(4):438-439. doi:10.1001/jamaophthalmol.2017.4271

A 25-year-old man with a history of rheumatoid arthritis currently taking oral methotrexate, 25 mg per week, presented with a lesion of the left bulbar conjunctiva of about 1 month’s duration. He had no other symptoms other than occasionally noticing a sensation of a foreign body in that eye and denied any changes in his vision. He had no history of contact lens use, ocular trauma, or ocular surgery. His only other medications were oral vitamin D and folic acid. He was initially treated with topical antibiotics followed by a course of oral sulindac, 200 mg twice daily, without any improvement.

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