Perifosine-related rapidly progressive corneal ring infiltrate

Purpose: To report a case of unilateral rapidly progressing corneal ring infiltration in a patient being treated with the investigational drug perifosine for Waldenström's macroglobulinemia. Methods: Interventional case report. Results: A 55-year-old woman who was receiving treatment with perifosine for Waldenström's macroglobulinemia developed a corneal ring infiltrate in her left eye. She was treated with topical antibiotics and systemic antiviral medication, but the ring infiltrate continued to expand, resulting in complete stromal opacification and a total epithelial defect. Repeated microbiologic tests, including corneal biopsy, failed to identify an infectious agent. Weeks after instituting systemic immunosuppressive medications, including corticosteroids and cyclophosphamide, the ocular inflammation gradually resolved with corneal re-epithelialization and severe stromal neovascularization. Conclusion: Patients treated with perifosine should be monitored for ocular adverse events. Perifosine-related corneal infiltration may progress rapidly and, after appropriate microbiologic examination, aggressive anti-inflammatory therapy should be considered.