Inverse hypopyon as the presenting feature of infectious scleritis in a case of tropical pyomyositis

A 25-year-old man presented with inverse hypopyon due to dense inflammatory exudation in the left eye. He was an ascetic with a history of long pilgrimages barefoot. Drainage of the pyogenic material with superficial exploration revealed localized scleral thinning at 2'o clock. Two days later, a thigh abscess was noted, which on ultrasonography showed hypoechoic areas with increased muscle mass suggestive of tropical pyomyositis. The culture from anterior chamber aspirate grew Staphylococcus aureus, as did 200 mL of pus drained from the thigh. His ocular condition improved significantly with high-dose systemic antibiotics.

To our knowledge, this unusual presentation of infectious scleritis and coexistent pyomyositis has not been previously reported in the literature.