Author: Nicolás Álamos López (Spain)
Co-authors: Daniel Montané Esteve, Carlos Galisteo Lencastre de Veiga, Carlos Cuesta Acero
Purpose
Describe a case report of a patient, of South American origin, who had been vaccinated against BCG in childhood, and who presented in our center with a diagnosis of idiopathic posterior nodular scleritis of the left eye and whose treatment with corticosteroids shows a excellent response with total remission of symptoms and stability over time.
Setting/Venue
This case was studied at our ophthalmology center at the Parc Tauli Hospital in Sabadell, Barcelona, Spain with a follow-up between July 2020 and January 2021.
Methods
Descriptive follow-up over a 6-month period, using retinography, optical coherence tomography (OCT) and angiography images.
Results
We present a case of a 28-year-old woman with no other known morbid history. She consulted the ophthalmology emergency room of our department, referring episodes of periocular pain in the left eye of 3 weeks of evolution, which partially soothed with non-steroidal anti-inflammatory drugs, and sometimes woke her up at night. He presented visual acuity (VA) of 1.0 in the right eye (RE) and 0.32 in the left eye (LE). Intraocular pressure (IOP) 19/22. On physical examination, she presented pain with eye movements in all gaze positions, somewhat more increased with levoversion. The LE biomicroscopy showed mild conjunctival hyperemia, the rest unremarkable. In the fundus (FO); RE without alterations and LE, exudative retinal detachment was evidenced at the level of the supero-temporal quadrant, which caused folds in the retina with macular distortion. Optic nerve without alterations. It was decided to study using complementary images. The LE's optical coherence tomography (OCT) showed an exudative retinal detachment. B-mode ultrasound revealed increased scleral thickness in the area of injury. Promptly assessed by the Uveitis Unit, and given these findings, it was decided to request an orbital magnetic resonance imaging (MRI) that reported a slight thickening and enhancement of the temporal-superior margin of the ocular globe and posterior sclera of LE, compatible with Posterior Nodular Scleritis. . Treatment was started with methylprednisolone bolus of 500 mg for 3 days and overlap with oral prednisone at a dose of 1mg / kg / day. At the follow-up in 2 weeks, she presented a frank decrease in pain. AV 1.0 / 0.65. IOP 24/21. Nondescript anterior pole. FO LE with a frank decrease in scleral thickening but small retinal whitish alteration in the TS arch. The control OCT LE no longer showed subretinal fluid. Given clinical and imaging improvement, it was decided to decrease the descending regimen of oral corticosteroids. Currently the patient has no symptoms and is still in check-ups at our hospital.
Conlusions
Posterior nodular scleritis is a very rare disease, mainly prevalent in females. Many times it has no known etiology. The importance of the case lies in having a high diagnostic suspicion that avoids overtreatment and that fortunately can have an excellent visual prognosis. Due to the antecedents presented in our patient despite having suspected a tuberculosis origin, the excellent clinical response to corticosteroids, the normalization of visual acuity and its stability over time led us to an idiopathic origin.
Financial Disclosure
I have no personal financing relationship.
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