scleritis.pptx case discussion in detail

Case discussion on scleritis

1. A CASE PRESENTATION ON SCLERITIS PRESENTER:- DR PRIYANKA MADRE MOMALE SETH GSMC & KEMH MUMBAI MODERATOR :- DR AVINASH B INGOLE DR ANAMIKA H AGRAWAL

2. CASE REPORT : 53 years old male C/O painless , bluish discoloration in left eye since 10-11 months Systemically patient complaints of 1. Large Joint pain since 1 year 2. Intermittentt Low grade fever a/w chills , Breathlessness since 2 months for which he was under evaluation patient is a k/c/o 1. Hypertension on treatment since 7 yrs 2.Rheumatoid arthritis not on any treatment with secondary mild mitral valve prolapse with mitral regurgitation 3.Anemia of chronic disease

3. HISTORY OF TREATMENT TAKEN TILL NOW Consulted elsewhere i /v/o same ocular complaints for which 3 days of IV Methylprednisolone was given followed by oral steroid tapering with topical steroids after which redness was resolved. One unit PCV transfusion I/v/o anemia .

4. CASE REPORT : NEGATIVE HISTORY NO HISTORY OF ALLERGY BONE DEFORMITY / FREQUENT FRACTURES PREVIOUS SUCH COMPLAINTS FAMILY HISTORY OF SIMILAR COMPLAINTS TRAUMA TO EYE PHOTOPHOBIA,PAIN,DIMINUTION OF VISION NO HISTORY OF

5. GENERAL EXAMINATION Afebrile Pulse-88/min RR-18/min BP-110/70mmHg Spo2 98% on Room air Pallor+ NO Icterus/Cyanosis/clubbing/ edema / Lymphadenopathy

6. SYSTEMIC EXAMINATION : WNL

7. NORMAL QUIET, NO CELLS SINGLE CIRCULAR,SLUGGISH RTL IMC 10MMHG RIGHT EYE LEFT EYE 6/6(-2.50DSP) BCVA 6/9(-2.50/-3.00X120) LID AND ADNEXA CORNEA& SCLERA ANTERIOR CHAMBER IRIS PATTERN PUPIL LENS IOP (GAT) OCULAR EXAMINATION: ANTERIOR SEGMENT NORMAL CLEAR 14MMHG IMC SINGLE CIRCULAR RTL NORMAL QUIET, NO CELLS WHITISH CORNEAL OPACITY WITH ADJESCENT BLUISH DISCOLORATION NORMAL

8. OCULAR EXAMINATION:SLIT LAMP EXAMINATION OS OD

9. Violaceous discoloration of sclera without signs of inflammation s/o scleral thinning on temporal side with overlying conjunctival vessels

10. OCULAR EXAMINATION :FUNDUS EXAMINATION OS OD M-CLEAR 0.3CDR,PINK DISC, WDM MACULA WNL FR PRESENT

11. OCULAR EXAMINATION : ULTRASONOGRAPHY OS NO E/O POSTERIOR SCLERITIS

12. INVESTIGATIONS ECG: Normal Sinus Rhythm HbA1c 5.9%(5.7-6.4) ANA: Weak Positive (Speckled and spindle fibre) ANCA : negative TPHA : negative ASLO test: Positive RA factor: Positive IGRA; Negative Sputum Gene Xpert : MTB not detected 2D ECHO EF 60%Mild MR/MVP/Trivial TR

13. CXR : Right middle zone haziness HRCT Chest reveals patchy areas of air space consolidation in the right middle lobe with multiple small ground glass opacities showing 'reversed halo sign' scattered in both lungs as described above. The exact etiology remains undetermined, however, possibility of infective process may have to considered and needs sputum correlation to determine precise etiology . Bronchoscopy done under sedation WNL, Bronchial wash taken from right lower lobe anterior and superior segment, right middle lobe medial and lateral segment Likely infective in a k/c/o RA+ etiology Genexpert -MTB not detected fungal CS-negative bacterial CS-negative Cytology Negative for Malignancy INVESTIGATIONS

14. DIFFERENTIAL DIAGNOSIS BASED ON CLINICAL EXAMINATION: PERIPHERAL CORNEAL ULCER ANTERIOR UVEITIS ANTERIOR CHAMBER SIGNS OF UVEITIS SYTEMIC ASSOCIATION NON-NECROTIZING SCLERITIS WITHOUT INFLAMMATION

15. DIFFERENTIAL DIAGNOSIS BASED ON CLINICAL EXAMINATION: EPISCLERITIS MILD/NO PAIN SALMON PINK COLOUR CONGESTION BLANCHING ON 10PERCENT PHENYLEPHRENE MOBILE ACUTE CONJUNCTIVITIS FORNEAL CONGESTION SPARING OF LIMBUS A/W FOLLICLE/PAPILLAE A/W DISCHARGE OSTEOGENESIS IMPERFECTA BONE DEFORMITY H/O FREQUENT MULTIPLE FRACTURES

16. DIAGNOSIS Right eye : Myopia Left eye: Scleromalacia with peripheral corneal opacity involving 4 to 5 O’clock in a known case of rheumatoid arthritis with secondary mild mitral valve prolapse with mitral regurgitation with hypertension with anemia of chronic disease with recently diagnosed right middle lobe consolidation likely organizing pneumonia.

17. TREATMENT: .

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