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Presentation type	E-poster
Title	When the eye reveals systemic disease: peripheral ulcerative keratitis as the presenting sign of anti-MDA5-positive dermatomyositis

Purpose	To report peripheral ulcerative keratitis (PUK) revealing anti-melanoma differenciation-associated gene 5 (anti-MDA5)-positive dermatomyositis.
Methods	A 52 year-old man developed a painful red left eye, photophobia, tearing and progressive visual loss seven months after left pterygium surgery. Ophthalmic, infectious and autoimmune assessments were performed.
Results	Visual acuity was 7/10 in the right eye and counting fingers at 50 centimeters in the left eye. Slit-lamp examination showed conjunctival hyperemia and a clean-based, crescent-shaped marginal corneal ulcer with severe thinning and impending perforation from 10 to 12 o'clock. Spontaneous and pressure-induced Seidel tests were negative. Bacterial and fungal cultures, parasitological testing, and viral and syphilis serologies were negative. Complete blood count, platelet count, C-reactive protein, erythrocyte sedimentation rate, serum protein electrophoresis, albumin and ferritin were within normal limits. Anti-MDA5 antibodies were positive, and internal medicine assessment supported dermatomyositis. Treatment combined intravenous methylprednisolone 1 g/day for three days, oral prednisone 1mg/kg/day, topical corticosteroids, antibiotic prophylaxis and ocular-surface support. At eight months, the globe remained intact without corneal perforation.
Conclusion	A sight-threatening corneal ulcer may be the first clinical clue to systemic autoimmunity. PUK requires urgent exclusion of infection and multidisciplinary assessment, even when the Seidel test is negative. Early recognition may preserve vision while revealing potentially severe systemic disease.
Conflict of interest	No

Authors 1

Last name	GUESSOUS
Initials	Y
Department	Ophthalmology (Cliniques universitaires saint-Luc)
City	Brussels

Authors 2

Last name	ZAFAD
Initials	R
Department	Ophthalmology (Al Madina Clinic)
City	Casablanca

Authors 3

Last name	DIOURI
Initials	S
Department	Faculty of Medicine (Université Libre de Bruxelles)
City	Brussels