Hemophilus influenzae-associated scleritis – A case report with a review of the literature

Abstract

We report a challenging clinical course of Hemophilus influenzae (H. influenzae) scleritis with a review of the literature. A 62‐year‐old lady with a history of progressing necrotizing scleritis over 7 months, negative for infection on scleral explorations, was given pulse doses of intravenous cyclophosphamide after she failed conventional immunomodulation. After two doses, she developed a tiny area of pus pointing, which was explored and subjected to microbiology. Though cultures were negative, PCR showed H. influenzae. She received intravenous ceftriaxone [2 g/day for 5 days], oral clarithromycin [500 mg twice daily for 14 days] and hourly fortified piperacillin, tazobactam and ceftazidime eyedrops. In addition, she received subconjunctival injections of ceftazidime. At 4 months follow‐up, the scleritis had resolved completely. At 1 year follow‐up, there was no recurrence of scleritis. H. influenzae is a rare cause of infectious scleritis. This case highlights the diagnostic challenge and the clinical course in such a case.