What are the symptoms of peripheral ulcerative keratitis?

Question

Hi doctor,

I noticed a crescent-shaped white mark in one of my eyes. I tried looking up information, but ultimately found nothing of value. Around the end of the year, I decided to go to an ophthalmologist. Around a month later, I got a rash on the lower third of my face. It would not go away, it was painful and itchy. I got a cold, and it lasted around two weeks.

Even after it went away my nose would not stop running, sometimes there would be blood along the discharge for weeks, I had phlegm on my throat that stills persists to this day (as well as the runny nose), my vision worsened, I have had around three ear infections, one of my eyes looks less opaque than the other (the one with the injury). I have nose pain, headaches that last a few days, joint pain all over, and cuts in the inside of my mouth.

I went to another ophthalmologist, and she insisted that I visit a rheumatologist. I did not get an official diagnosis, but we think the eye injury is peripheral ulcerative keratitis. A day before visiting the rheumatologist, my throat suddenly closed, my voice became hoarse, and I had trouble breathing.

The doctor told me those sorts of eye ulcers are usually related to rheumatic and autoimmune diseases, so he ordered a bunch of studies. They were all negative, and he insisted I looked fine. I have spent a lot of money, and doctors always brush me off when they see the negative labs, but I do not feel fine, and I am scared it will turn out to be something serious.

Please help.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

Autoimmune and systemic inflammatory diseases can sometimes present with significant symptoms even when initial laboratory tests are negative, especially in the early stages. The eye findings, particularly peripheral ulcerative keratitis (PUK), are strongly associated with underlying autoimmune conditions, such as rheumatoid arthritis, granulomatosis with polyangiitis (Wegener’s), and other systemic vasculitides, even when standard markers like ANCA (anti-nuclear cytoplasmic antibody or ANA (anti-nuclear antibody) are negative.

Your additional symptoms, such as chronic sinus issues, bloody nasal discharge, recurrent ear infections, persistent upper respiratory involvement, oral ulcers, joint pain, and even that episode of throat narrowing, are concerning and may point toward a small-vessel vasculitis or an evolving connective tissue disease that is not yet seropositive.

This may represent what is known as “seronegative disease,” where clinical features are present but the laboratory tests remain negative. Given your symptoms and ocular involvement, I would recommend proceeding with a more thorough immunologic and imaging workup: consider sinus and chest CT (computerized tomography) to evaluate for granulomatous changes, serum IgG subclasses, complement levels (C3, C4), and possibly even a biopsy of accessible inflamed tissue (such as nasal mucosa) if symptoms persist.

It may also be worth trialling treatment if your clinical picture strongly supports an autoimmune inflammatory process, as early intervention could prevent irreversible organ damage. You are not imagining these symptoms, and we should not dismiss your clinical picture based solely on laboratory tests.

I hope this information will help you.

Thanks.