Bilateral Red Eyes Research Articles

Bone and joint disease – Not always a rheumatological diagnosis

Abstract A 17-year-old female presented with a 7-day history of joint pains involving the bilateral knee, ankle and small joints of the hands and feet symmetrically, associated with bilateral knee joint swelling and early morning stiffness and bilateral red eyes. General examination was normal except for pallor. Musculoskeletal system examination revealed bilateral swollen and tender knee joints with restriction of movement along with tenderness in the bilateral shoulder, elbow, ankle joints and spine from T3 to T7 thoracic vertebral levels. Examination of other systems was normal. Investigations showed anaemia, elevated urea and creatinine. Skeletal survey showed multiple lytic lesions. Positron emission tomography revealed multiple punched-out lytic lesions in skull bones, scapulae, sternum, clavicles, ribs on both sides, vertebrae at multiple levels and in pelvic girdle bones. Few lesions showed mild 18fluorodeoxyglucose (18FDG) uptake, metaphyseal moth-eaten lysis in long bones with mild FDG uptake. Bone marrow biopsy and immunohistochemistry confirmed the diagnosis of acute B-cell lymphoblastic leukaemia. The terminology is according to 2016 revision of WHO classification of myeloid neoplasms and acute leukemia.

Bilateral combined anterior and posterior scleritis – A case of organ-limited idiopathic vasculitis

We present a case of a 69-year-old female with complains of bilateral painful red eyes and blurred vision. The patient was treated elsewhere for allergic conjunctivitis and then came here for a second opinion. The patient was diagnosed as a case of bilateral anterior plus posterior scleritis based on clinical findings, optical coherence tomography (OCT), and ultrasound B-scan reports. Thorough systemic evaluation for the possibility of infection and systemic vasculitis was performed based on a rheumatologist opinion. Topical and systemic steroids along with cyclophosphamide were started after admitting the patient for diabetes monitoring. The patient regained the best corrected vision from 6/12 to 6/6 with complete resolution of OCT findings after 15 days. This case highlights the importance of thorough eye check-up including posterior segment evaluation in all cases of scleritis and a multi-disciplinary approach in order to achieve early remission of the episode.

RED EARS, RED EYES AND HEARING LOSS: A DIAGNOSTIC DILEMMA

Relapsing polychondritis (RP) is a disease that confounds clinicians worldwide due to the difficulty in confirming its diagnosis and determining the best treatment plan. We report a case of a 34-year-old lady who presented with bilateral inflamed auricular swelling and red eyes, which turned out to be relapsing polychondritis. The patient was successfully treated with long-term oral steroids and is on regular follow-up. This report highlights how the subtle signs of her condition were picked up, leading to her diagnosis of RP and the treatment regime that successfully reversed her symptoms. The challenge of picking up subtle signs of the disease is best met by working as a team in a multidisciplinary setting. A literature study shows that RP is a rare disease that can present with many symptoms.

Tubulointerstitial nephritis and uveitis syndrome post-COVID-19.

Tubulointerstitial nephritis and uveitis syndrome post-COVID-19.

Ocular Manifestations of Coronavirus Disease 2019 (COVID-19): Its Remedy and Prevention

SARS-CoV-2 is a Coronavirus that causes COVID-19 with mild to severe respiratory illness. It is highly contagious disease transmitted through direct or indirect contact with infected people or contaminated surfaces mainly through respiratory droplets. Several research articles are published which evaluated the ocular findings in patients with Coronavirus disease 2019. Commonly patients are suffering from initial ocular symptoms followed by systemic symptoms of the disease. Transmission even from the ocular surface could be possible via tears and other secretions through eyes. The most frequently noted initial symptom of COVID-19 is follicular conjunctivitis with acute and diffuse bilateral red eye. Similarly other ocular manifestations include eye Corneal sub epithelial infiltrates with epithelial defects,episclerits,acute anterior Uveitis, Retinitis, Optic neuritis, Cataract, Vitreous hemorrhages and cranial nerve palsies. As a remedy for ocular manifestation, orally administered Ribavirin has been used in vision threatening cases. For mild to moderate ocular symptoms ,antihistaminic eye drops with ocular lubricating drops and cool compress are till now applied. To be in safe side and to prevent the transmission from the ocular surfaces, all eye care practitioners are advised to wear personal protective equipment including gowns, gloves, masks and face shields during the ophthalmic procedures.

Bilateral uveitis following nivolumab and ipilimumab treatment for mesothelioma

AbstractPurpose: Case report of a patient presenting with sudden onset of painful decreased vision in both eyes, diagnosed with Intermediate uveitis and keratitis. We will review the diagnostic pathway and the management of this case, as well as the correlation with the systemic treatment of that time.Results: A 63‐year‐old male presented in the Emergency department with bilateral red painful eyes and blurred vision. The patient had a past ophthalmic history of keratouveitis in RE and medical history of mesothelioma for which he had recently started treatment with Nivolumab and Ipilimumab. The visual acuity on presentation was 6/9 in the RE and 6/6 in the LE. Upon examination BE were hyperaemic, there was a past corneal scar in the RE and bilateral KPs. RE had +1 AC inflammation and LE traces of AC inflammation. No signs of posterior segment inflammation were seen in both eyes. The patient was treated initially with oral Aciclovir 400 mg BD and Pred Forte 1% in BE QDS. One week after initiation of treatment symptoms improved and a tapering regime of the local steroid treatment was given. Four weeks later the visual acuity in the RE was 6/12 and 6/9 in the LE. Upon examination there was +1 AC activity in BE and +1 vitreous activity. OCT demonstrated bilateral macular oedema. An FFA revealed bilateral optic disc hyperfluorescence. Upon further discussion of the patient's medical history it was revealed that both episodes of intraocular activity coincided with his infusions of Nivolumab and Ipilimumab. The patient was advised to discontinue the oral Aciclovir treatment and was initiated on intensive regime of local steroids which was tapered on improvement of the vision and the inflammation. Our ocular findings were communicated the patient's oncology team that decided to discontinue the above treatment.Conclusions: Nivolumab is an anti‐programmed cell death protein‐monoclonal. It is used for cancer treatment but case reports have emerged of uveitis and ocular surface disease. Ipilimumab is a humanized CLTA‐4 antibody and it can be associated with immune related adverse events such as uveitis. Our patient was switched to a different treatment protocol without further ocular inflammation and excellent visual outcome. Clinicians should raise their index of suspicion in side effects around the timing of treatment.

Aortitis Secondary to Cogan’s Syndrome: A Rare Cause of Fever of Unknown Origin

Fever of unknown origin is a diagnostic challenge with an extensive list of possible causes.The coexistence of fever, aortitis, ocular and vestibulo-cochlear symptoms should raise the suspicion of Cogan's syndrome.Steroid therapy is the first-line treatment for Cogan's syndrome.

The Sequelae of Bilateral Conjunctivitis as an Initial Presentation of Presumed COVID-19 Positive Female

Background and ObjectivePresented is a case of a 28-year-old female, who was diagnosed with presumed COVID-19 (SARS-CoV-2) and the sequelae of her bilateral conjunctivitis. Since December 2019, the presence of severe acute respiratory syndrome COVID-19 has swept worldwide, infecting over 170 million to date and counting. It has been discovered that the virus can make its way to the eyes due to an abundance of human angiotensin-converting enzyme-2 on the conjunctiva. There are limited reports accounting for bilateral keratocon-junctivitis associated with SARS-CoV-2, and even less reporting as the initial symptom and the sequelae of the ocular findings that can be associated with a COVID-19 positive patient. In this report, the signs, symptoms, management, and treatment of COVID-19 related keratoconjunctivitis will be discussed. MethodsPresented is a case of a 28-year-old female diagnosed with presumed COVID-19 and the sequelae of her bilateral conjunctivitis.ResultA 28-year-old female initially presented to her local emergency room on 7/9/2020 for bilateral red eyes and loss of taste and smell. She tested positive for COVID-19 at that time via a polymerase chain reaction nasopharyngeal swab. There was no conjunctival swab or serology testing of her tears performed. Her ocular symptoms persisted for an additional 3 weeks when she finally presented to our clinic, with bilateral keratoconjunctivitis, after testing negative for the virus 14 days prior.ConclusionThis case presents findings of an initial presentation of bilateral conjunctivitis secondary to presumed COVID-19. The sequelae of the patient’s ocular findings after testing negative for COVID-19 were of specific interest. This case provides a resource to help guide eye care professionals in proper questioning of those diagnosed with COVID-19 about ocular symptoms they had initially, as well as symptoms that occurred after systemic resolution of the virus infection. Furthermore, this case can help educate eye care professionals on the possible sequalae, management, and treatment of COVID-19-related keratoconjunctivitis to ensure full resolution of its effect and provide a good visual outcome for patients. We will continue to learn more about COVID-19 and its effects on the eye as well as the effect of COVID-19 vaccines on ocular manifestations of the virus.

Coexistence of Relapsing Polychondritis and Sickle Cell Disease in a Child

Relapsing polychondritis (RP) is a rare, severe connective tissue disease of unknown etiology affecting cartilaginous and proteoglycan-rich structures in an episodic and inflammatory manner. Approximately a third of RP cases occur in conjunction with another disease usually systemic autoimmune rheumatic disease, or myelodysplastic syndrome. Sickle cell disease (SCD) is a common inherited hematologic condition characterized by the inheritance of two abnormal hemoglobins, of which one is a hemoglobin S, presenting with severe acute and chronic complications from vaso-occlusive phenomena, which can be difficult to differentiate from RP. The pathogenesis of RP is poorly understood but suggests an autoimmune mechanism with a link to sickle cell disease yet to be established. Treatment is empiric with steroids, anti-inflammatory, and disease-modifying antirheumatic drugs being the mainstay of therapy. Severe complications occur despite treatment, with respiratory involvement being the most catastrophic. This case report reviews a complex case of RP in an 11-year-old girl with sickle cell disease (SF genotype) presenting with bilateral red painful eyes, a painful swollen left ear, and knee pain. Laboratory findings revealed elevated inflammatory markers with negative immune serology. A diagnosis of RP was made based on the patient's symptomatology, presentation, and fulfillment of 5 out of the 6 clinical features using McAdam's criteria. Management was instituted with a myriad of conventional and biologic DMARDs and other anti-inflammatory medications with no significant improvement and the development of complications of airway obstruction from disease activity and osteoporotic fracture from steroid therapy and underlying hemoglobinopathy. In children, the diagnosis of RP is delayed or overlooked due to its low incidence, variability in clinical symptoms, or sharing similar clinical features with other coexisting disease entities. This article reports its occurrence in the pediatric population and highlights the difficulty in managing such cases as there are no defined standard treatment protocols.

O28 A rare sight-threatening complication of a rare disease

Case report - IntroductionRelapsing polychondritis (RP) is a rare autoimmune disorder characterised by inflammation of cartilaginous structures throughout the body. It usually presents in the fourth and sixth decade, and commonly affected areas include the nasal and respiratory tracts, external ears and joints. Ocular involvement is reported in around 65% of RP patients during their lifetime but is rarely sight-threatening. However, we present an unusual case of recurrent ocular inflammation due to RP that resulted in unilateral posterior scleritis with sub-retinal exudation, and posed a high risk of retinal detachment. Prompt escalation of immunosuppressive treatment was required to prevent this.Case report - Case descriptionA 48-year-old man of south-east Asian descent presented to rheumatology in December 2020 with a typical history of new inflammatory arthritis of 4 weeks duration. He was known to have bilateral episcleritis and ocular hypertension for 3 years and took Brinzolamide and Latanoprost eye drops, as well as metformin for type 2 diabetes mellitus. The only other relevant history was treatment with antibiotics as an inpatient for bilateral pinna cellulitis 2 months prior, which was suspected to be related to his diabetes. Examination revealed mildly reduced hand grips but no definite synovitis. The most remarkable finding was bilateral painless red eyes. Both pinnae appeared inflamed on close inspection without obvious auricular lobe involvement. Blood tests showed raised C-Reactive Protein (38 mg/L), and Erythrocyte Sedimentation Rate (62 mm/hr), with normochromic normocytic anaemia but other blood counts were normal. Renal and liver function was normal. Detailed immunology was negative.Relapsing Polychondritis was suspected and confirmed following multidisciplinary team (MDT) discussions with the Ear Nose and Throat and ophthalmology teams. At the next visit, his disease progressed to florid polyarthritis in a rheumatoid distribution. This responded well to low-dose prednisolone and methotrexate. However, the patient attended eye casualty on multiple occasions over the next 6 weeks with alternating acute eye pain and redness, mildly reduced visual acuity and raised intraocular pressures. He developed sub-retinal fluid pockets suggestive of posterior scleritis in the right eye and retinal tomography demonstrated extensive pigment clumping especially in the macula with outer retinal disruption. Urgent pulses of intravenous methylprednisolone were given, followed by high-dose prednisolone tapering. The case was discussed with the regional uveitis MDT, and treatment was escalated to adalimumab. He is currently 1 month into treatment and has preserved visual acuity and stable intraocular pressures, with no other systemic involvement of his RP.Case report - DiscussionThe diagnosis of RP requires a high index of clinical suspicion given the lack of diagnostic markers. The clinical features are multisystem and might not occur simultaneously as in this case, where the eye disease preceded the ear and joint manifestations by a couple of years. Perichondritis might be more difficult to appreciate in patients with darker skin and can further delay diagnosis. The average time to diagnosis from the initial symptoms has been reported as 14 months from a case series of 158 patients with RP in China.Ocular complications are usually bilateral and the commonest are episcleritis and scleritis (over 50% of cases have one of these), followed by uveitis and retinopathy. Eyelid oedema, proptosis and optic neuritis can also occur but are rarer, and exudative retinal detachment has only been noted in a small number of case reports. Unfortunately, no current treatment guidelines exist for RP due to a lack of randomised controlled trials but treatment is usually guided by the severity of manifestations in conjunction with trends from case series and expert opinion. The aim is to halt or slow disease progression and glucocorticoids are often used first-line for moderate to severe disease, with or without the addition of steroid-sparing agents such as methotrexate, ciclosporin and azathioprine. A meta-analysis of biologics in RP conducted by Kemta et al. in 2012 has suggested anti-TNF (particularly Infliximab) might be beneficial as second-line treatment for severe or refractory cases of organ involvement due to RP such as central nervous system, nasal or pulmonary involvement. However, due to the extreme rarity of both RP and associated severe retinal disease, the optimum therapeutic choice in this setting is currently not known.Case report - Key learning pointsRP remains a challenging clinical diagnosis with a common delay in diagnosis of more than 1 year from the onset of symptoms. High index of suspicion and MDT input can aid earlier diagnosis and treatment to mitigate further complications.Eye disease occurs in up to two-thirds of patients with RP but exudative retinal or subretinal involvement is very rare. It can occur even when other manifestations of RP are well-controlled with immunosuppression as in this case.Anti-TNF treatment could be used to minimise visual loss in these severe cases of inflammatory eye disease due to RP, given reported benefit for other organ-threatening complications of RP. However, future case series are needed to guide evidence-based treatment choices.

O30 Case report of Cogan syndrome in a child with audiovestibular dysfunction and ocular inflammation

Case report - IntroductionCogan syndrome is a very rare disorder of probable autoimmune vasculitic origin, first described in 1934. The age of onset seems to range from 3 to 50 years with an average age of disease onset at 29 years. It is characterised by audiovestibular dysfunction and ocular inflammation. The cause remains unknown and the epidemiology of the disease is purely based on case reporting. As of 2015, there were fewer than 250 case reports. Interestingly, it seems extremely rare in Arabic and Middle Eastern countries in which a new case has been recently diagnosed and is being reported in this abstract.Case report - Case descriptionA 14-year-old girl of Arabic origin first presented to the ENT specialist with a 3-week history of balance problems, left tinnitus and sensorineural hearing loss in both ears worse on the left. She first received treatment for vestibular neuritis with no improvement. Two months later, she complained of bilateral red eyes and excessive lacrimation when diffuse interstitial keratitis was diagnosed by the ophthalmologist. An array of blood tests including a full autoimmune disease was arranged and a rheumatology opinion was sought.The patient had a normal inflammatory response and her screen for antinuclear antibodies, extractable nuclear antigen, rheumatoid factor and antineutrophil cytoplasmic antibodies were all negative. A full virology screen was also negative. Having failed to respond to all supportive treatment modalities, a trial of a tapering 2-week course of prednisolone starting at 25mg daily was instigated. The patient’s symptoms improved by more than 50% on glucocorticoids subsequent to which the diagnosis of Cogan syndrome was anticipated. As the patient’s symptoms relapsed when glucocorticoids were stopped, she was recommenced on prednisolone 25mg in line with azathioprine 100mg daily. The patient’s hearing, which was almost lost in the left ear, improved significantly by more than 70% initially, and then to normal hearing as stated by the patient supported by special ENT testing. Her balance problems and vertigo also improved remarkably. Her tinnitus, which was the last symptom to resolve, almost went away over the subsequent 2 months. The patient had already come off glucocorticoids 6 months down the line, and stayed on azathioprine 75-100mg daily for almost a year after which gradual weaning was trialled and then eventually succeeded. She has now been off azathioprine for 6 months without experiencing any disease relapse.Case report - DiscussionCogan syndrome can be difficult to diagnose particularly in children. The diagnosis is essentially clinical depending on the presence of audio-vestibular symptoms and interstitial keratitis along with a prompt response to immunosuppressive medication.In this patient, the consistent clinical picture supported by the positive response to glucocorticoids especially in the absence of an alternative diagnosis would have made the diagnosis of Cogan syndrome likely.Given the rarity of this disorder, there are no classification criteria as yet hence the ongoing need for case reporting. Moreover, there is no clear guidance on the duration of immunosuppressive treatment of this condition.Case report - Key learning pointsIt is pivotal in managing conditions with a suspected autoimmune origin to have a multidisciplinary approach involving other relevant specialties in a holistic approach.The prompt response to glucocorticoid therapy still remains the key in securing the diagnosis of a number of conditions in clinical practice especially in the absence of diagnostic criteria and/ or supportive investigations such as serological and tissue-based testing.Case reporting has a crucial role in enhancing awareness of rare medical conditions.

Ocular manifestations in patients with corona virus disease (COVID-19)

Introduction: Corona virus disease (COVID-19) has affected many subspecialties including ophthalmology. We aimed to determine the ocular manifestations of COVID-19 patients treated in a dedicated tertiary care hospital, in Nepal.
 Method: This was a descriptive cross-sectional study in hospitalized COVID-19 patients in Patan Hospital, Patan Academy of Health Sciences, Kathmandu, Nepal. Data were collected during 6 months from November 2020 to May 2021 to achieve a for a specified sample size of 90. Ophthalmological manifestations were recorded in the consenting participants. Ethical approval was obtained.
 Result: One or more ocular manifestations were seen in 3.4% of admitted COVID-19 patients. Bilateral diffuse red eyes was the most common manifestation.
 Conclusion: Bilateral diffuse red eye was the common ocular manifestation in admitted COVID-19 patients.

Bilateral anterior non-necrotising scleritis, anterior uveitis, and unilateral facial nerve palsy in paediatric inflammatory multisystem syndrome temporally associated with COVID-19.

A 17-year-old boy was referred to the ophthalmology service at St Thomas' Hospital (London, UK) with bilateral red eyes, bilateral eye pain independent of eye movement that disturbed his sleep, photophobia, and mild, subjective blurring of vision. He had become infected with SARS-CoV-2 5 weeks before referral and had been diagnosed with paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) and associated myocarditis.

Fever, uveitis, and myocarditis as the initial presentation of Behcet's Disease: A case report and review of the literature

Behcet's disease (BD) is an inflammatory disease characterized by recurrent aphthous ulcers, genital ulcers, and eye involvement. The involvement of the vascular system, heart, lungs, gastrointestinal tract, and the brain is less common, and BD myocarditis is very rare, with only a few cases reported in the literature. The prevalence of BD is variable globally, with Turkey having the highest prevalence, with 370 cases/100,000 population. Out of the 17 criteria proposed for the diagnosis of BD, the most commonly used criteria are the International Study Group (ISG) on BD criteria and the “International Criteria of BD” (ICBD) criteria. We present a case of a 40-year-old female who presented with fever of unknown origin, oral ulcers, odynophagia, and a rash over the face, extremities, and trunk. She developed acute-onset bilateral painful red eyes in the hospital with marked diminution of vision and persistent tachycardia. On evaluation, she was diagnosed to have bilateral intermediate uveitis based on the clinical finding of conjunctival congestion, and 1+ cells in the anterior chamber of both eyes, dispersion of iris pigments on the anterior surface of lens bilaterally, and Grade 1 vitreous haze on slit-lamp examination. The patient had persistent tachycardia for which an electrocardiogram was done, which revealed nonspecific ST-changes. Echocardiography was done, which showed a left ventricular ejection fraction of 40%, with global hypokinesia, suggestive of myocarditis. Our patient fulfilled the ICBD criteria, and she tested positive for human leukocyte antigen B51. She also had persistent transaminitis, and on evaluation, she was found to have occult hepatitis B infection with possible reactivation. The final diagnosis of BD with myocarditis and occult hepatitis B infection was established. She was managed with oral glucocorticoids, colchicine, azathioprine, and entecavir with a favorable outcome. BD causing myocarditis is an infrequent presentation, and we could find only 15 cases reported in the literature since 1947 when Dr. Hulusi Behcet first described the disease.

Bilateral nodular episcleritis due to Varicella-Zoster virus

The patient is a 10 years-old girl, with chief complaint of recent bilateral red eye and history of chickenpox disease. Examination revealed nodular episcleritis of both eyes. After treatment with topical steroids, the disease was subsided. Varicella-Zoster virus is a rare cause of episcleritis. In this case it seems that the mechanism of involvement is immune-related, rather than direct tissue involvement by virus. Bilateral nodular episcleritis due to Varicella-Zoster virus

Bilateral Anterior Uveitis Revealing Relapsing Polychondritis

Relapsing polychondritis is a potentially lethal but rare systemic autoimmune disease. The major site of inflammation is the connective tissue, usually involving the ears, nose, larynx, tracheobronchial tree, and cardiovascular system. Although scleritis and episcleritis are known to be the most probable ocular manifestation, it may also present with uveitis. We present the case of a 22-year-old young lady who initially referred with bilateral red and painful eyes caused by anterior uveitis. Her right ear was also red and painful, consistent with cartilaginous inflammation. She was diagnosed with relapsing polychondritis with bilateral anterior uveitis and chondritis of the ear in conjunction with the rheumatology department. Bilateral anterior uveitis should evaluated and monitored carefully in patients with relapsing polychondritis.

Ocular toxocariasis caused by toxocara canis in an adult woman. Case report

Introducción. La toxocariasis es una zoonosis producida por las larvas de los nematodos Toxocara canis y Toxocara cati, parásitos intestinales de los cánidos y los félidos, respectivamente.Presentación del caso. Paciente femenino de 22 años de edad, procedente de Caquetá, Colombia, con un cuadro de 3 meses de evolución con pérdida de visión en ojo izquierdo, acompañada de dolor ocular, diplopía, fotofobia y ojo rojo bilateral, quien presenta desprendimiento de retina en ojo izquierdo diagnosticado por ecografía. La mujer asiste a oftalmología, donde se hace diagnóstico diferencial con retinoblastoma y pars planitis. Se inicia manejo sintomático con corticoides orales y tópicos, con mejoría de la sintomatología, pero persistencia de pérdida de la agudeza visual.Discusión. Al revisar historial de antecedentes socioeconómicos, la paciente convive con perros y gatos, por lo que se piensa en toxocariasis ocular. En el cuadro hemático se observa ligera leucocitosis y linfocitosis, sin eosinofilia. La determinación de anticuerpos anti-Toxoplasma gondii y anti-cisticerco de Taenia solium resultaron negativas, al igual que el VDRL. El test de ELISA para T. canis fue positivo, con unos títulos IgG de 1:64 (positivo ≥1:32, especificidad >90%). Se inicia manejo con corticoide oftálmico, sistémico, albendazol y vitrectomía. Con la intervención quirúrgica se libera banda vítrea, logrando la desaparición de la diplopía, pero persiste granuloma periférico residual, el cual será intervenido por oftalmología.Conclusiones. Dada la posibilidad de ser confundida con un retinoblastoma —una neoplasia maligna que puede requerir la enucleación del ojo—, el conocimiento de esta forma de presentación de la toxocariasis es de suma importancia para los clínicos.

Case report: A Rare Yet Life Threatening Mimicker of Chronic Conjunctivitis

Wegener’s granulomatosis (WG) is a necrotizing granulomatous inflammation. A 40-year-old lady of Malay descent presented with unresolving bilateral painful red eyes for three weeks. Clinical examination revealed that best corrected vision acuity of 6/9 for both eyes. Slit lamp examination revealed diffuse scleritis. Other Investigations result like UFEME blood cell: 2+, C-reactive protein 70.06 mg/L and ESR of 125mm/h suggestive on acute inflammations. Connective tissue screening revealed cytoplasmic ANCA was positive and was supported by Anti –Serine Protease3 (PR3) 68. All the investigations results revealed that she had Wegener’s granulomatosis with ophthalmology manifestation in the form scleritis. Patient was treated with guttae Maxidex QID to reduce cells that present in anterior chamber and oral ibuprofen 400mg thrice daily. Subsequently, commence oral prednisolone, oral cyclophosphamide with oral Bactrim. Patient responded well and redness resolved. There are many differential diagnosis for chronic conjunctivitis but to rule out connective tissue disease should be one of the primary differential diagnosis in young female. Oral immunosuppressive and Trimethoprim /Sufmethoxazole (Bactrim) has been found beneficial and symptoms were resolved . Wegener's granulomatosis is a great mimicker as exemplified in this case. This disease can be misdiagnosed and maltreated as conjunctivitis.Thus we wished to emphasize that WG is one the differential that need to be consider in a person with bilateral scleritis.Â

Bilateral interstitial keratitis with anterior stromal infiltrates associated with reactive arthritis

A previously healthy 48-year-old man presented with a 1-week history of migrating polyarthropathy preceded by a viral illness, dysuria and bilateral red eyes. Ocular examination revealed anterior and interstitial stromal...

Encephalocraniocutaneous Lipomatosis: Case Report of a Rare Disorder

Encephalocraniocutaneous lipomatosis (ECCL), a rare neurocutaneous syndrome is characterized by profound mental retardation, early onset of seizures, unilateral temporofrontal lipomatosis, ipsilateral cerebral and leptomeningeal lipomatosis, cerebral malformation, calcification, lipomas of skull, eye, heart, connective tissue nevi along with alopecia. This case highlights the condition in a 4 day old male child who presented with bilateral red eye with mass lesion. Complete evaluation showed conjunctival hyperemia, lipodermoids with corneal vascularisation and healed choroiditis patches OD. Systemic work up revealed ipsilateral nevus psiloliparus, and undescended testis with megalourethra. Radiologic evaluation showed revealed diffuse cerebral atrophy, subarachnoid cyst in right temporal region along with dysplastic cortex, enlargement of both ventricular system and extra-axial CSF spaces along with marked atrophy of right antero-inferior temporal parenchyma. Child was managed conservatively and over a one year follow up the ocular condition remained unchanged with OU limbal lipodermoids and no conjunctival congestion.