Abstract
Purpose. To describe a case of anterior nodular scleritis, preceded by an anterior hypertensive uveitis, which was primarily caused by varicella zoster virus (VZV). Case Report. A 54-year-old woman presented with anterior uveitis of the right eye presumably caused by herpetic viral disease and was successfully treated. Two months later, she developed a nodular scleritis and started oral nonsteroidal anti-inflammatory without effect. A complete laboratory workup revealed positivity for HLA-B27; the infectious workup was negative. Therapy was changed to oral prednisolone and an incomplete improvement occurred. Therefore, a diagnostic anterior paracentesis was performed and the polymerase chain reaction (PCR) analysis revealed VZV. She was treated with valacyclovir and the oral prednisolone began to decrease; however, a marked worsening of the scleritis occurred with the reduction of the daily dose; subsequently, methotrexate was introduced allowing the suspension of the prednisolone and led to clinical resolution of the scleritis. Conclusion. This report of anterior nodular scleritis caused by VZV argues in favor of an underlying immune-mediated component, requiring immunosuppressive therapy for clinical resolution. The PCR analysis of the aqueous humor was revealed to be a valuable technique and should be considered in cases of scleritis with poor response to treatment.
Highlights
Scleritis is defined as an inflammation of the sclera
We present an unusual case of infectious scleritis by varicella zoster virus (VZV), which only improved after the immunosuppressor association, supporting the immunemediated hypothesis
Scleritis has a wide spectrum of clinical presentations and etiologic factors, varying from idiopathic to autoimmune or infectious and coursing with variable severity and outcomes
Summary
Scleritis is defined as an inflammation of the sclera. It is classified as anterior or posterior, to the anatomic site of the disease, and the anterior scleritis can be divided into subtypes: diffuse, nodular, and necrotizing [1, 2]. Mediated diseases are the main disorders associated with scleritis, some of which are with systemic involvement and other restricted solely to the eye, in an organ-specific autoimmune disease [1, 2]. Attending to the similarity of its presentation, infectious scleritis is often initially managed as autoimmune [7]. Within the infectious agents of scleritis, varicella zoster (VZV) is the virus most often implicated [8]. We present an unusual case of infectious scleritis by VZV, which only improved after the immunosuppressor association, supporting the immunemediated hypothesis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
