Diffuse granulomatous necrotizing scleritis

Acta Ophthalmologica Scandinavica
Irene PecorellaPaola Pivetti Pezzi

Abstract

A 34-year-old man presented with anterior scleral thinning in the right eye (RE) and a painful nodular scleritis in the left eye (LE). Fundus examination showed a healed vasculitis and an inferior epiretinal neovascular membrane in the LE. Topical and systemic oral steroids and antiviral medication were prescribed. One year later, optic disc hyperaemia and swelling and macular oedema became apparent in the LE. Pulsed intravenous steroids were administered for 1 year, when a nasal septum perforation and vitreous haemorrhage in the LE were diagnosed. The eye was enucleated 3.5 years after the initial complaint. Necrotizing granulomatous tissue replacing the sclera and subconjunctival granulomatous tissue were observed. Six months later, oedema and neovascularization of the right optic disc were observed and cyclophosphamide was started, with regression of the clinical signs. No systemic abnormalities have so far become apparent. Posterior scleritis is most often observed in patients with no signs of associated systemic autoimmune disease. The diagnosis in this case is most probably one of Wegener's granulomatosis (WG). In WG, the diagnosis is based on necrotizing granulomas of the respiratory tract, generalized focal necrotizing ...Continue Reading

References

Apr 1, 1991·Ophthalmology·S J Tuft, P G Watson
Jul 16, 1999·Ophthalmology·W P RionoN A Rao

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Citations

Mar 25, 2014·Ocular Immunology and Inflammation·Rebecca C StacyLucia Sobrin
Sep 11, 2018·Journal of Current Ophthalmology·Mahmoud NejabatMohammad Hassan Jalalpour

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