A monocular patient admitted for pyoderma gangrenosum flare complained of decreased vision and left eye pain. Four years prior she had scleritis OD which requiring scleral reinforcement surgery after which the patient was lost to follow up, developed endophthalmitis and eventually required enucleation. Her vision was 20/800 OS, intraocular pressure was 8, and external exam was notable for severe conjunctival and episcleral congestion with superior scleral necrosis. Though no systemic autoimmune or inflammatory disease could be diagnosed from her laboratory evaluation, her history of scleritis OD and presence of pyoderma gangrenosum suggested an autoimmune driver as cause of her scleritis. Scleritis and pyoderma gangrenosum are extra-intestinal manifestations of inflammatory bowel disease that may occur independently of gastrointestinal flares. Colonoscopy therefore may diagnose subclinical luminal disease. The patient was treated with IV steroids followed by an oral steroid taper as rituximab was initiated. Scleral necrosis progressed to a full thickness scleral hole with uveal exposure. Given her history and assessment of the globe, decision was made to increase systemic steroids rather than surgical intervention. At last follow up she had sufficient structural globe integrity with halted scleral necrosis and no conjunctival epithelial defect.
Presentation Date: 02/16/2023
Issue Date: 03/03/2023