The Atypical Red Eye: A Case of Scleritis with Peripheral Ulcerative Keratitis Secondary to Granulomatosis with Polyangiitis

• Published in: Case reports in ophthalmology Vol. 14; no. 1; pp. 140 - 146
• Main Authors: Bonnet, Louis Antoine, Lipsky, Lior, Holmes, Richard
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2023; Karger Publishers
• Subjects: Biopsy; Case Report; Case reports; Cornea; Epistaxis; granulomatosis with polyangiitis; Hematuria; Histopathology; Inflammatory diseases; Medical prognosis; Mortality; Ophthalmology; Otolaryngology; peripheral ulcerative keratitis; Remission (Medicine); Rheumatology; scleritis; Serology; Urology; Vein & artery diseases; wegener’s granulomatosis; Granulomatosis with polyangiitis; Scleritis; Peripheral ulcerative keratitis; Wegener’s granulomatosis
• ISSN: 1663-2699; 1663-2699
• DOI: 10.1159/000529459

Abstract This report presents a rare case of scleritis with peripheral ulcerative keratitis secondary to granulomatosis with polyangiitis (GPA). A 65-year-old Caucasian male presented to a regional ophthalmology service with an atypical red eye. His immune work-up demonstrated positive anti-neutrophil cytoplasmic IgG autoantibodies (ANCA) with anti-proteinase 3 antibody (PR3) elevation. Multi-system vasculitis was discovered including lung, liver, bladder, prostate, nasal and paranasal sinuses involvement. His ocular sequelae included significant peripheral corneal thinning requiring cyanoacrylate gluing, juxtalimbal conjunctival resection, and bandage lens placement. He was treated with systemic methylprednisolone and rituximab achieving remission with ongoing prednisone and methotrexate maintenance therapy. This case demonstrates the importance of recognizing ocular manifestations of GPA as a first presentation of systemic vasculitis.