Scleritis and sclerokeratitis associated with IgA vasculitis: A case series

Purpose

To describe a case series of scleritis associated with IgA vasculitis (IgAV) at a tertiary referral center.

Observations

Three men with scleritis associated with IgAV were identified: one with anterior scleritis alone, one with anterior scleritis and peripheral ulcerative keratitis (sclerokeratitis), and one with anterior and posterior scleritis. Visual acuity was preserved except from the patient who developed posterior scleritis. Ocular pain was the main symptom at presentation. All patients had a previous history of palpable purpura, but only one was aware of his underlying IgAV. Laboratory results revealed microhematuria and proteinuria with normal urinary β₂ microglobulin levels and negative serum ANCAs. Skin or kidney biopsy demonstrated leukocytoclastic vasculitis or glomerulonephritis with dominant IgA immune deposits.

Conclusions and Importance

Although uncommon, IgAV should be included in the differential diagnosis of anterior scleritis alone or associated with peripheral ulcerative keratitis or posterior scleritis, even in systemically asymptomatic patients. Urinalysis should not be underestimated in assessment of scleritis to detect early stages of glomerular disease. Scleritis may be the first manifestation whose study may lead to the diagnosis of IgAV. Multidisciplinary approach is necessary to prevent irreversible organ damage such as renal failure.

Atypical Tolosa Hunt syndrome with bilateral sclerokeratitis and optic atrophy in Takayasu's arteritis

Purpose

We report an interesting case of atypical Tolosa Hunt syndrome with bilateral Sclerokeratitis and optic atrophy in a patient with Takayasu's arteritis.

Observations

A 31-year- old lady presented with severe retroorbital pain in the right eye and right sided headache of 2 weeks duration. She had a history of 6th and 7th nerve palsies which improved with oral corticosteroids. Her BCVA was no perception of light in OD and 6/6 in OS. Slitlamp examination showed bilateral old sclerokeratitis and fundus examination showed bilateral optic atrophy. Systemic examination revealed BP of 240/100 mm of hg in the right upper limb with absent pulsations in the left radial, bilateral femoral and dorsalis pedis arteries noted. CT aortic angiography confirmed the diagnosis of Takayasu's arteritis. Symptoms improved with oral corticosteroids and azathioprine, which was followed by a renal stenting procedure. At 1 year followup, she is doing well with no recurrences.

Conclusions and importance

This case report presents a unique manifestation of atypical Tolosa Hunt syndrome in Takayasu's arteritis. To our knowledge, atypical Tolosa Hunt syndrome in Takayasu'arteritis has not been described in literature.