Oman Journal of Ophthalmology

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

Pseudomonas aeruginosa scleritis initially presenting as idiopathic diffuse anterior scleritis


Shweta Agarwal1, Parthopratim Dutta Majumder2,  
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

Correspondence Address:
Dr. Parthopratim Dutta Majumder
Department of Uvea, Sankara Nethralaya, 18, College Road, Nungambakkam, Chennai - 600 006, Tamil Nadu
India

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.



How to cite this article:
Agarwal S, Majumder PD. Pseudomonas aeruginosa scleritis initially presenting as idiopathic diffuse anterior scleritis.Oman J Ophthalmol 2020;13:51-52


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 2022 May 27 ];13:51-52
Available from: https://www.ojoonline.org/text.asp?2020/13/1/51/278552


Full Text



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}

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

1Chaidaroon W, Supalaset S. Pseudomonas scleritis following pterygium excision. Case Rep Ophthalmol 2017;8:401-5.
2Chao DL, Albini TA, McKeown CA, Cavuoto KM. Infectious after strabismus surgery. J AAPOS 2013;17:423-5.
3Jain V, Garg P, Sharma S. Microbial scleritis-experience from a developing country. Eye (Lond) 2009;23:255-61.