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Nodular Posterior Scleritis: A Clinical Case Report

Received: 17 December 2021     Accepted: 4 January 2022     Published: 12 January 2022
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Abstract

Background: Scleritis is a rare inflammation of the outer coat of the eye, which is often characterized by pain and redness and may be associated with visual loss and blindness. Posterior scleritis may lead to the formation of a choroidal mass which is often confused with choroidal tumors. A delayed and an inaccurate diagnosis may lead to devastating outcomes, that including unnecessary enucleation. Therefore, a prudent clinical judgement is necessary. Objective: To report clinical characteristics of an outstanding posterior scleritis which required a multidisciplinary collaboration for its management. Method: A young man presented with redness and diminished vision in his right eye for 5 days. A detailed ophthalmological examination was completed, which suggested a final diagnosis of posterior nodular scleritis that was presumed to occur secondary to anti-neutrophil cytoplasmic antibodies-associated granulomatosis with polyangiitis. A multimodal imaging workup suggested posterior nodular scleritis and laboratory investigation confirmed positive antineutrophil cytoplasmic antibodies (C-ANCAs). All other infectious and immunological tests came negative. The patient was subsequently treated with systemic steroids and immunomodulatory therapy, with an excellent visual recovery. Best-corrected visual acuity improved from 20/200 at presentation to 20/25 at eight months after the therapy, and there was no evidence of disease recurrence. Conclusion: Nodular posterior scleritis is an important but benign disease that may mimic an intraocular tumor. Multimodal imaging studies and detailed laboratory investigations are essential for its correct diagnosis and appropriate management.

Published in International Journal of Ophthalmology & Visual Science (Volume 7, Issue 1)
DOI 10.11648/j.ijovs.20220701.11
Page(s) 1-5
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Nodular Posterior Scleritis, Granulomatosis with Polyangiitis, C-ANCA, Ultrasonography, Intraocular Mass

References
[1] Vergouwen, D., et al., Current insights in the pathogenesis of scleritis. Experimental Eye Research, 2020. 197: p. 108078.
[2] Lavric, A., et al., Posterior scleritis: analysis of epidemiology, clinical factors, and risk of recurrence in a cohort of 114 patients. Ocular immunology and Inflammation, 2016. 24 (1): p. 6-15.
[3] McCluskey, P. J., et al., Posterior scleritis: clinical features, systemic associations, and outcome in a large series of patients. Ophthalmology, 1999. 106 (12): p. 2380-2386.
[4] Watson, P. and S. S. Hayreh, Scleritis and episcleritis. British Journal of Ophthalmology, 1976. 60 (3): p. 163-191.
[5] Agrawal, R., et al., Nodular posterior scleritis: clinico-sonographic characteristics and proposed diagnostic criteria. Retina, 2016. 36 (2): p. 392-401.
[6] Nevares, A., et al., Noninfectious autoimmune scleritis: recognition, systemic associations, and therapy. Current rheumatology reports, 2020. 22 (4): p. 1-10.
[7] Alsarhani, W. K. and A. M. A. El-Asrar, Multimodal imaging of nodular posterior scleritis: Case report and review of the literature. Middle East African Journal of Ophthalmology, 2020. 27 (2): p. 134.
[8] Ally, N. and A. Makgotloe, Nodular Posterior Scleritis Masquerading as a Subretinal Mass. Middle East African Journal of Ophthalmology, 2020. 27 (4): p. 231.
[9] Sharma, R., S. Marasini, and B. Nepal, Tubercular scleritis. Kathmandu University Medical Journal, 2010. 8 (3): p. 352-356.
[10] Watson, P. and A. Romano, The impact of new methods of investigation and treatment on the understanding of the pathology of scleral inflammation. Eye, 2014. 28 (8): p. 915-930.
[11] Shukla, D. and R. Kim, Giant nodular posterior scleritis simulating choroidal melanoma. Indian journal of ophthalmology, 2006. 54 (2): p. 120-122.
[12] Liu, A. T., F. O. Luk, and C. K. Chan, A case of giant nodular posterior scleritis mimicking choroidal malignancy. Indian journal of ophthalmology, 2015. 63 (12): p. 919.
[13] Compatible, E. and L. Coroides, Giant nodular posterior scleritis compatible with ocular sarcoidosis simulating choroidal melanoma. Arch Soc Esp Oftalmol, 2007. 82: p. 563-566.
[14] Feldon, S. E., et al., Clinical manifestations of brawny scleritis. American journal of ophthalmology, 1978. 85 (6): p. 781-787.
[15] Finger, P. T., et al., Posterior scleritis as an intraocular tumour. British journal of ophthalmology, 1990. 74 (2): p. 121-122.
[16] Mathis, T., et al., New concepts in the diagnosis and management of choroidal metastases. Progress in retinal and eye research, 2019. 68: p. 144-176.
[17] Arevalo, J. F., et al., Circumscribed choroidal hemangioma: characteristic features with indocyanine green videoangiography. Ophthalmology, 2000. 107 (2): p. 344-350.
[18] Akpek, E. K., et al., Evaluation of patients with scleritis for systemic disease. Ophthalmology, 2004. 111 (3): p. 501-506.
[19] Comarmond, C. and P. Cacoub, Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment. Autoimmunity reviews, 2014. 13 (11): p. 1121-1125.
Cite This Article
  • APA Style

    Armando Bautista-Barba, Erick Andres Quiroz-Gonzalez, Miguel Angel Quiroz-Reyes, Jhoana Sanchez-Ruiz, Rafael Valdez-Sosa, et al. (2022). Nodular Posterior Scleritis: A Clinical Case Report. International Journal of Ophthalmology & Visual Science, 7(1), 1-5. https://doi.org/10.11648/j.ijovs.20220701.11

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    ACS Style

    Armando Bautista-Barba; Erick Andres Quiroz-Gonzalez; Miguel Angel Quiroz-Reyes; Jhoana Sanchez-Ruiz; Rafael Valdez-Sosa, et al. Nodular Posterior Scleritis: A Clinical Case Report. Int. J. Ophthalmol. Vis. Sci. 2022, 7(1), 1-5. doi: 10.11648/j.ijovs.20220701.11

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    AMA Style

    Armando Bautista-Barba, Erick Andres Quiroz-Gonzalez, Miguel Angel Quiroz-Reyes, Jhoana Sanchez-Ruiz, Rafael Valdez-Sosa, et al. Nodular Posterior Scleritis: A Clinical Case Report. Int J Ophthalmol Vis Sci. 2022;7(1):1-5. doi: 10.11648/j.ijovs.20220701.11

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  • @article{10.11648/j.ijovs.20220701.11,
      author = {Armando Bautista-Barba and Erick Andres Quiroz-Gonzalez and Miguel Angel Quiroz-Reyes and Jhoana Sanchez-Ruiz and Rafael Valdez-Sosa and Gerardo Ledesma-Gil and Miguel Pedroza-Seres and Federico Graue-Wiechers},
      title = {Nodular Posterior Scleritis: A Clinical Case Report},
      journal = {International Journal of Ophthalmology & Visual Science},
      volume = {7},
      number = {1},
      pages = {1-5},
      doi = {10.11648/j.ijovs.20220701.11},
      url = {https://doi.org/10.11648/j.ijovs.20220701.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20220701.11},
      abstract = {Background: Scleritis is a rare inflammation of the outer coat of the eye, which is often characterized by pain and redness and may be associated with visual loss and blindness. Posterior scleritis may lead to the formation of a choroidal mass which is often confused with choroidal tumors. A delayed and an inaccurate diagnosis may lead to devastating outcomes, that including unnecessary enucleation. Therefore, a prudent clinical judgement is necessary. Objective: To report clinical characteristics of an outstanding posterior scleritis which required a multidisciplinary collaboration for its management. Method: A young man presented with redness and diminished vision in his right eye for 5 days. A detailed ophthalmological examination was completed, which suggested a final diagnosis of posterior nodular scleritis that was presumed to occur secondary to anti-neutrophil cytoplasmic antibodies-associated granulomatosis with polyangiitis. A multimodal imaging workup suggested posterior nodular scleritis and laboratory investigation confirmed positive antineutrophil cytoplasmic antibodies (C-ANCAs). All other infectious and immunological tests came negative. The patient was subsequently treated with systemic steroids and immunomodulatory therapy, with an excellent visual recovery. Best-corrected visual acuity improved from 20/200 at presentation to 20/25 at eight months after the therapy, and there was no evidence of disease recurrence. Conclusion: Nodular posterior scleritis is an important but benign disease that may mimic an intraocular tumor. Multimodal imaging studies and detailed laboratory investigations are essential for its correct diagnosis and appropriate management.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Nodular Posterior Scleritis: A Clinical Case Report
    AU  - Armando Bautista-Barba
    AU  - Erick Andres Quiroz-Gonzalez
    AU  - Miguel Angel Quiroz-Reyes
    AU  - Jhoana Sanchez-Ruiz
    AU  - Rafael Valdez-Sosa
    AU  - Gerardo Ledesma-Gil
    AU  - Miguel Pedroza-Seres
    AU  - Federico Graue-Wiechers
    Y1  - 2022/01/12
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    DO  - 10.11648/j.ijovs.20220701.11
    T2  - International Journal of Ophthalmology & Visual Science
    JF  - International Journal of Ophthalmology & Visual Science
    JO  - International Journal of Ophthalmology & Visual Science
    SP  - 1
    EP  - 5
    PB  - Science Publishing Group
    SN  - 2637-3858
    UR  - https://doi.org/10.11648/j.ijovs.20220701.11
    AB  - Background: Scleritis is a rare inflammation of the outer coat of the eye, which is often characterized by pain and redness and may be associated with visual loss and blindness. Posterior scleritis may lead to the formation of a choroidal mass which is often confused with choroidal tumors. A delayed and an inaccurate diagnosis may lead to devastating outcomes, that including unnecessary enucleation. Therefore, a prudent clinical judgement is necessary. Objective: To report clinical characteristics of an outstanding posterior scleritis which required a multidisciplinary collaboration for its management. Method: A young man presented with redness and diminished vision in his right eye for 5 days. A detailed ophthalmological examination was completed, which suggested a final diagnosis of posterior nodular scleritis that was presumed to occur secondary to anti-neutrophil cytoplasmic antibodies-associated granulomatosis with polyangiitis. A multimodal imaging workup suggested posterior nodular scleritis and laboratory investigation confirmed positive antineutrophil cytoplasmic antibodies (C-ANCAs). All other infectious and immunological tests came negative. The patient was subsequently treated with systemic steroids and immunomodulatory therapy, with an excellent visual recovery. Best-corrected visual acuity improved from 20/200 at presentation to 20/25 at eight months after the therapy, and there was no evidence of disease recurrence. Conclusion: Nodular posterior scleritis is an important but benign disease that may mimic an intraocular tumor. Multimodal imaging studies and detailed laboratory investigations are essential for its correct diagnosis and appropriate management.
    VL  - 7
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Author Information
  • Ophthalmology Department, Institute of Ophthalmology Conde de Valenciana Foundation, National Autonomous University of Mexico, Mexico City, Mexico

  • Ophthalmology Department, Institute of Ophthalmology Conde de Valenciana Foundation, National Autonomous University of Mexico, Mexico City, Mexico

  • Retina Service, Institute of Ophthalmology Conde de Valenciana Foundation, National Autonomous University of Mexico, Mexico City, Mexico

  • Ophthalmology Department, Institute of Ophthalmology Conde de Valenciana Foundation, National Autonomous University of Mexico, Mexico City, Mexico

  • Uvea Department, Institute of Ophthalmology Conde de Valenciana Foundation, National Autonomous University of Mexico, Mexico City, Mexico

  • Retina Service, Institute of Ophthalmology Conde de Valenciana Foundation, National Autonomous University of Mexico, Mexico City, Mexico

  • Uvea Department, Institute of Ophthalmology Conde de Valenciana Foundation, National Autonomous University of Mexico, Mexico City, Mexico

  • Retina Service, Institute of Ophthalmology Conde de Valenciana Foundation, National Autonomous University of Mexico, Mexico City, Mexico

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