Posters

Necrotizing scleritis: inflammatory, infectious or both? A case report

Poster Details

First Author: H.Hamdani MOROCCO

Co Author(s): I. Hanafi   S. Fati   L. El Maaloum   B. Allali   H. El Kabli   A. El Kettani     

Abstract Details

Purpose:

The purpose of this case is to assess the difficulty in making the difference between an infectious or an autoimmune scleritis in the context of systemic diseases such as rheumatoid arthritis

Setting:

University Hospital 20 Août Casablanca

Methods:

A 74 years old female, followed for a diabetes mellitus for 36 years under insulin, and rheumatoid arthritis (RA) under methotrexate stopped 1year before the consultation . She also beneficiated from a cataract surgery in her right eye and a vitrectomy due to vitreous hemorrhage. She consulted at the ophtalmic emergencies for a red right eye with purulents secretions. At the ophtalmic examination we found : visual acuity OD at counting fingers from 2m, a conjunctival hyperemia, purulent secretions, a dense keratitis, and IOL in place.

Results:

The patient was first treated with local antibiotics and artificial tears. 5 days after, she developped a corneal ulcer wich motivated the addition of Aciclovir 3g per day. After one week, the corneal ulcer healed but she developped a necrotizing scleritis. At this point, a herpetic necrotizing scleritis or a complication of her RA was discussed. After consulting the internists, both aciclovir and corticosteroids were prescribed. The evolution was marked by the development of a stationnary scleromalacia.

Conclusions:

Doing things apart between an inflammatory or infectious necrotizing scleritis is difficult, and may lead to a delay in treatment and serious complications. As seen in this case, corneal involvement tip the scale for an infectious origin, but the incomplete recovery required adjunction of a systemic treatment for her RA.

Financial Disclosure:

None