Case report: A Rare Yet Life Threatening Mimicker of Chronic Conjunctivitis

Abstract

Wegener’s granulomatosis (WG) is a necrotizing granulomatous inflammation. A 40-year-old lady of Malay descent presented with unresolving bilateral painful red eyes for three weeks. Clinical examination revealed that best corrected vision acuity of 6/9 for both eyes. Slit lamp examination revealed diffuse scleritis. Other Investigations result like UFEME blood cell: 2+, C-reactive protein 70.06 mg/L and ESR of 125mm/h suggestive on acute inflammations. Connective tissue screening revealed cytoplasmic ANCA was positive and was supported by Anti –Serine Protease3 (PR3) 68. All the investigations results revealed that she had Wegener’s granulomatosis with ophthalmology manifestation in the form scleritis. Patient was treated with guttae Maxidex QID to reduce cells that present in anterior chamber and oral ibuprofen 400mg thrice daily. Subsequently, commence oral prednisolone, oral cyclophosphamide with oral Bactrim. Patient responded well and redness resolved. There are many differential diagnosis for chronic conjunctivitis but to rule out connective tissue disease should be one of the primary differential diagnosis in young female. Oral immunosuppressive and Trimethoprim /Sufmethoxazole (Bactrim) has been found beneficial and symptoms were resolved . Wegener's granulomatosis is a great mimicker as exemplified in this case. This disease can be misdiagnosed and maltreated as conjunctivitis.Thus we wished to emphasize that WG is one the differential that need to be consider in a person with bilateral scleritis.