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Necrotising fungal scleritis with full-thickness scleral melt and circumferential progression: a novel debridement approach
  1. Samendra Karkhur,
  2. Deepak Soni and
  3. Bhavana Sharma
  1. Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
  1. Correspondence to Dr Samendra Karkhur; karkhurs{at}gmail.com

Abstract

A 44-year-old Asian Indian woman presented with a history of pain and redness in the left eye for 3 weeks. Scleral congestion with a nodular swelling was present inferotemporally. Raised C reactive protein and positive antinuclear and perinuclear antineutrophil cytoplasmic antibodies suggested autoimmune scleritis. The patient was therefore managed with corticosteroids. Nevertheless, the development of severe pain associated with a scleral abscess led to a revised diagnosis of infectious scleritis. Corticosteroids therapy was halted and urgent debridement was performed. Microbiology confirmed fungal scleritis due to Coprinopsis cinerea. Multiple full-thickness circumferential debridements with antifungal therapy resulted in satisfactory anatomical and visual outcomes. This case presented a unique challenge, since laboratory results were misleading, and corticosteroids resulted in a fulminant clinical course. Therefore, aggressive circumferential debridement was performed to achieve the elimination of a rare fungal aetiology of scleritis, which has not been reported previously to cause human infection.

  • eye
  • ophthalmology

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Footnotes

  • Contributors SK worked up and clinically managed the case. SK and DS performed literature review and drafted the manuscript. BS critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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