Posters

Necrotizing scleritis in a patient with rheumatoid arthritis: case report and literature review

Poster Details

First Author: N.Lorenzana Blanco SPAIN

Co Author(s):    F. Romero Bueno   O. Sánchez Pernaute   G. Fernández Sanz   N. Alejandre Alba           

Abstract Details

Purpose:

To offer a recognition pattern to identify similar rare cases and to guide management and treatment in clinical practice.

Setting:

Fundación Jiménez Díaz University Hospital, Madrid, Spain.

Methods:

We report a clinical case of a A 73-year-old woman who switched her immunosuppressive treatment for her late-onset seropositive erosive rheumatoid arthritis to homeopathic therapies for 4 years with one-month history of ocular pain. Visual acuity tests, symptoms, slit-lamp examinations and photographic imaging were collected during follow-up. Blood tests, hand and hip radiographs and infection screening were carried out for diagnosis assessment. Video imaging were taken during surgery. We compare this patient to a systematic literature review and identify distinguishing clinical features.

Results:

Regarding our clinical case, intravenous corticosteroid pulses followed by oral tapering plus intravenous cyclophosphamide (Euro-Lupus) were indicated for rapid control of inflammation because of the impending large diameter perforation and a possible diagnosis of granulomatosis with polyangiitis at first. Treatment was later switched to oral methotrexate. Patient underwent scleral graft with amniotic membrane transplantation while on intravenous treatment. Systemic activity was controlled and eye function preserved. A literature review addresses current insights in treatment and management of necrotizing anterior scleritis.

Conclusions:

Proper management of ocular complications in patients with inflammatory diseases is essential from early stages to avoid serious consequences ranging from decreased vision to ocular perforation. It is noteworthy the importance of multidisciplinary approach as sometimes surgical and immunosuppressive treatments are required to stop and repair the damage.

Financial Disclosure:

None