FP1547 : Double Trouble Leading to Corneal Melt with Resistant Scleritis – A Clinical Challenge

Dr. Jivitesh Singh, Dr. S Bala Murugan, Dr. Annamalai O, Dr. Baljit Kaur

Purpose – To describe an association of acute necrotizing scleritis with autoimmune disorders and role of immunosuppressants in treatment.

Discussion – A 50 year old male presented with pain, redness, swelling and decreased vision in BE with RE 5/60 & LE 6/36. He was a known case of Rheumatoid Arthritis(RA) with positive history of epistaxis and dyspnea. He was diagnosed as acute necrotizing scleritis with corneal limbal melt in RE. Thorough lab workup and confirmatory diagnosis from biopsy of nasal polyp proved it to be necrotizing granulomatous vasculitis. With 2 major risk factors, rheumatoid arthritis and Wegener’s granulomatosis for acute necrotizing scleritis, treatment with prednisolone and cyclophosphamide were started. Improvement in both scleritis and visual acuity was seen to RE 6/24, LE 6/18.

Conclusion – Wegener’s granulomatosis and RA have strong association with severe scleritis but respond brilliantly well to cyclophosphamide.

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