CASE REPORT


Necrotizing Anterior Scleritis in a Woman with Terrien’s Marginal Degeneration: A Case Report



María Alejandra Fonseca-Mora1
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, Paula Tatiana Muñoz-Vargas1
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, Juliana Reyes-Guanes2
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, William Rojas-Carabali1
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, Miguel Cuevas3
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, Alejandra de-la-Torre1, *
iD

1 Neurosciences Research Group NeURos, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
2 Escuela Barraquer, Research Group, Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia
3 Department of Ophthalmology, Universidad de Antioquia, Medellin, Colombia


© 2021 Fonseca-Mora et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Neurosciences Research Group NeURos. Neurovitae Research Center. Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 24 # 63C 69, Bogotá, Colombia;
Tel: 2970200; Ext: 3320; E-mail: alejadelatorre@yahoo.com


Abstract

Purpose:

The aim of the study was to report the first case of a patient with Terrien’s Marginal Degeneration (TMD) who developed necrotizing anterior scleritis without systemic disease association, requiring systemic immunosuppressive treatment.

Case Report:

A 32-year-old female consulted for bilateral ocular burning and hyperemia. Initially, she was diagnosed with conjunctivitis and treated with topical antibiotics and corticosteroids, with mild transitory improvement but the progression of the disease. Years later, she attended the ocular immunology consultation for a second opinion where TMD with ocular inflammatory component OU was diagnosed. Seven months later, she presented with severe pain, decreased visual acuity, and photophobia in OS. At the slit-lamp examination, necrotizing anterior scleritis with a high risk of perforation in OS was observed. The patient was referred to the rheumatologist and started treatment with systemic corticosteroids and cyclophosphamide, exhibiting a clinical improvement. The patient did not meet the criteria for any systemic illness associated with scleritis, such as autoimmune diseases or vasculitis. Thus, scleritis was related to the adjacent inflammatory process associated with TMD, as an atypical presentation of this disease.

Conclusion:

Although an inflammatory type of TMD has been proposed, it is essential to follow up closely these patients and consider necrotizing anterior scleritis, a severe ocular disease that requires prompt immunosuppressive management, as a possible atypical associated presentation of this disease.

Keywords: Corneal diseases, Scleritis, Diagnosis, Terrien’s Marginal Degeneration, Case report, Ocular disease.