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Recalcitrant infective scleritis masquerading an autoimmune necrotising scleritis: a primary presentation of biopsy-proven granulomatosis with polyangiitis
  1. Rinky Agarwal1,
  2. Manasi Tripathi1,
  3. Seema Kashyap2 and
  4. Sanjay Sharma3
  1. 1Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
  2. 2Ocular Pathology, Dr RP Centre, All India Institute of Ophthalmic Sciences, New Delhi, India
  3. 3Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Rinky Agarwal; rinky.1990{at}gmail.com

Abstract

Infectious scleritis is a rare but important cause of scleral inflammation. It is usually associated with an underlying ocular (prior ocular surgery or trauma) or systemic risk factor. A 53-year-old apparently systemically healthy woman presenting with spontaneous-onset pain, redness and watering in the left eye for 10 days was diagnosed with culture-proven Pseudomonas aeruginosa anterior scleritis. However, she was non-responsive to organism-sensitive antibiotics and scleral graft was performed twice, which showed graft re-infection. On repeated extensive systemic evaluations, the patient was diagnosed with biopsy-proven granulomatosis with polyangiitis (GPA). The patient was started on mycophenolate mofetil for both induction and maintenance phases and showed dramatic improvement with no recurrence till 1 year follow-up. High index of suspicion for autoimmune disorders, especially GPA, must be maintained for unilateral relentless infective scleritis masquerading as autoimmune necrotising scleritis. Mycophenolate mofetil holds a promising role for inducing as well as maintaining disease remission in ocular GPA.

  • ophthalmology
  • anterior chamber

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Footnotes

  • Contributors RA contributed to manuscript preparation; MT was responsible for patient care and data collection; SK contributed to histopathological evaluation; SS contributed to radiologic evaluation.

  • 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.