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Bilateral tarsal conjunctival pigmentation and treatment failure: case report A 71-year-old woman developed bilateral tarsal conjuctival pigmentation during treatment with minocycline for pyoderma gangrenosum of the left lower extremity. Additionally, she exhibited prednisone treatment failure for pyoderma gangrenosum [not all routes and dosages stated]. The woman presented to the ophthalmology clinic with a 2 month history of several 1–2mm dark, brown growths with some pearliness around the inner aspect of both lower eyelids. One month prior to her dermatology appointment, she was informed about lower lid freckles by her primary care physician. At that time, she was unaware of pigmentation. She had pyoderma gangrenosum of the left lower extremity, for which she was followed up by a dermatologist for years. She was then referred by the dermatologist to ophthalmology for further examination. At current presentation, she denied discomfort, itching, changes in vision or any color or size change of the growths. An anamnesis showed that she was switched to minocycline by her dermatologist after prednisone failure, and she had been receiving oral minocycline 100mg twice daily since 8 months (cumulative dose 48g) to treat pyoderma gangrenosum along with several other co-medications. She had a history of bilateral cataract removal with intraocular lens implantation 4 years ago. No significant family and social history was noted. She did not receive any eye medications. Eye examination showed visual acuity of 20/25 in both eyes, pupils of 3mm, reactive to light and without any afferent pupillary defects. Right eye showed conjunctiva containing two small pigmented cysts infratemporally and subtle grey temporal scleral pigmentation. Left eye showed a small lower lid inclusion of pigment, three small, well-defined areas of inferior tarsal conjunctival pigmentation of less than 1mm diameter each, and two larger well-demarcated areas of inferior tarsal conjunctival pigmentation of 1mm in diameter each. Further examination of bilateral cornea, iris, anterior chamber and lens was unremarkable. Biopsy was postponed as she had history of minocycline use, unremarkable ocular adnexal structures, and the benign appearance under slit-lamp. After excluding various differential diagnoses, a diagnosis of minocycline-induced bilateral tarsal conjuctival pigmentation was made. The woman’s minocycline therapy was discontinued. She presented to the ophthalmology clinic after 2 months of minocycline discontinuation. At that time, the lesions were unchanged with benign appearance. Kudrna JJ, et al. Bilateral Tarsal Conjunctival Pigmentation After Eight Months of Minocycline Therapy. South Dakota Medicine 73: 360-365, No. 8, Aug 2020. Available 803505541 from: URL: https://pubmed.ncbi.nlm.nih.gov/32809295/

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Reactions 10 Oct 2020 No. 1825