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 Table of Contents    
PHOTO ESSAY
Year : 2020  |  Volume : 13  |  Issue : 1  |  Page : 51-52  

Pseudomonas aeruginosa scleritis initially presenting as idiopathic diffuse anterior scleritis


1 Department of Cornea, Sankara Nethralaya, Chennai, Tamil Nadu, India
2 Department of Uvea, Sankara Nethralaya, 18, College Road, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Submission20-Dec-2018
Date of Decision22-Oct-2019
Date of Acceptance25-Nov-2019
Date of Web Publication17-Feb-2020

Correspondence Address:
Dr. Parthopratim Dutta Majumder
Department of Uvea, Sankara Nethralaya, 18, College Road, Nungambakkam, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_256_2018

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   Abstract 


Pseudomonas aeruginosa remains the most common cause of bacterial scleritis. This report illustrates an unusual presentation of P. aeruginosa scleritis, which initially presented as diffuse anterior scleritis with anterior uveitis. The detailed laboratory work-up of the patient was negative, and the initiation of high-dose oral corticosteroid therapy led to further deterioration of clinical condition, with the appearance of a yellowish-white nodule within 3 days. The aspirate from the nodule grew P. aeruginosa, and the scleral inflammation resolved with anti-microbial therapy.

Keywords: Anterior diffuse scleritis, infective scleritis, Pseudomonas aeruginosa scleritis, scleritis


How to cite this article:
Agarwal S, Majumder PD. Pseudomonas aeruginosa scleritis initially presenting as idiopathic diffuse anterior scleritis. Oman J Ophthalmol 2020;13:51-2

How to cite this URL:
Agarwal S, Majumder PD. Pseudomonas aeruginosa scleritis initially presenting as idiopathic diffuse anterior scleritis. Oman J Ophthalmol [serial online] 2020 [cited 2020 Apr 3];13:51-2. Available from: http://www.ojoonline.org/text.asp?2020/13/1/51/278552



A 35-year-old immunocompetent male presented with severe ocular pain, redness in the right eye, and headache for 2 weeks. His best-corrected visual acuity (BCVA) was 6/12 in the right eye and 6/6 in the left eye. Slit-lamp examination of the right eye revealed diffuse congestion, engorgement of deeper episcleral vessels, which did not blanch with topical vasoconstrictor; cells 1+ cells, flare 1+ were noted in the anterior chamber with synechiae [Figure 1]a. Slit-lamp examination of the left eye and fundus examination of both eyes were unremarkable. A systemic evaluation for syphilis and tuberculosis was unrevealing, and the results of laboratory tests for vasculitis and systemic rheumatic disorders were within reference limits. Subsequently, he was started on high-dose oral steroid (1.5 mg/day). He felt symptomatically better with the treatment for initial 2 days but came back with severe excruciating pain in the right eye on the 3rd day. Slit-lamp examination of the right eye revealed diffuse congestion of the globe with appearance of a yellowish-white nodule on the temporal side [Figure 1]b. Culture from aspirate of the nodule showed growth of Pseudomonas aeruginosa, which was sensitive to ciprofloxacin. The patient was started on oral ciprofloxacin 500 mg twice a day and topical ciprofloxacin. He was monitored closely. At 2-month follow-up visit, he denied any ocular pain and his BCVA improved to 6/9. Slit-lamp examination of the right eye revealed resolved scleritis with a quiet anterior chamber [Figure 1]c.
Figure 1: (a) Slit-lamp photograph of the right eye at presentation showing diffuse anterior scleritis and anterior-chamber inflammation with synechiae; (b) slit-lamp photograph of the right eye showing appearance of yellowish-white scleral nodule, 3-day following high-dose oral steroid; (c) slit-lamp photograph of the right eye after 2 months of antimicrobial therapy showing resolution of scleral inflammation

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P. aeruginosa remains the most common cause of bacterial scleritis and has been reported after various surgical interventions such as pterygium surgery, strabismus surgery, or ocular trauma.[1],[2],[3] The index case reflects the importance of close follow-up in all cases of scleritis, especially after initiating immunomodulation. Our patient presented with diffuse anterior scleritis with anterior-chamber inflammation. There was no history of surgery or antecedent trauma, and he was initially diagnosed as noninfective scleritis. Appearance of yellowish-white scleral nodule with deterioration of symptoms following high-dose steroid led to the suspicion of infective component. High index of suspicion and close follow-up remain the mainstay of management of a case of infective scleritis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chaidaroon W, Supalaset S. Pseudomonas scleritis following pterygium excision. Case Rep Ophthalmol 2017;8:401-5.  Back to cited text no. 1
    
2.
Chao DL, Albini TA, McKeown CA, Cavuoto KM. Infectious after strabismus surgery. J AAPOS 2013;17:423-5.  Back to cited text no. 2
    
3.
Jain V, Garg P, Sharma S. Microbial scleritis-experience from a developing country. Eye (Lond) 2009;23:255-61.  Back to cited text no. 3
    


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