Bilateral posterior scleritis as a presenting manifestation of giant cell arteritis: A case report

Posterior scleritis is a rare and frequently misdiagnosed form of ocular inflammation that may be either idiopathic or associated with various systemic diseases. The systemic associations1 are similar to those observed in anterior scleritis and include rheumatoid arthritis, Wegener granulomatosis, systemic lupus erythematosus, systemic vasculitis, relapsing polychondritis, sarcoidosis, and other autoimmune diseases. Moreover, it may occur in isolation or associated with either anterior scleritis or anterior uveitis. Giant cell arteritis (GCA) is a systemic immune-mediated vasculitis that affects medium-sized and large arteries. GCA has a wide spectrum of clinical features related to both systemic inflammation and ischemia. The most common symptoms are headache, scalp tenderness, jaw claudication, and systemic manifestations (fever, weight loss, anorexia, and malaise). Ophthalmologic symptoms are common manifestations of GCA and may occur alone, without other symptoms of GCA. Arteritic anterior ischemic optic neuropathy (AAION) is the most common ophthalmologic manifestation. Other ocular manifestations are central or branch retinal artery occlusion and diplopia that results from ischemia of extraocular muscles or ocular motor nerves.2 A few other reports about the association of GCA with scleritis have appeared in the literature.3, 4 and 5 We report a case of bilateral posterior scleritis that was diagnosed in association with GCA.