Nodular Scleritis Associated with Herpes Zoster Virus: An Infectious and Immune-Mediated Process

Area of Science:

• Ophthalmology
• Virology
• Immunology

Background:

• Anterior uveitis and nodular scleritis are inflammatory eye conditions.
• Varicella zoster virus (VZV) is a known cause of ocular inflammation.
• Scleritis can be challenging to treat, sometimes requiring advanced diagnostic and therapeutic approaches.

Purpose of the Study:

• To report a case of anterior nodular scleritis.
• To highlight the role of varicella zoster virus (VZV) as a primary cause.
• To emphasize the importance of polymerase chain reaction (PCR) in diagnosis and the need for immunosuppressive therapy.

Main Methods:

• Case report of a 54-year-old woman with recurrent ocular inflammation.
• Initial treatment for presumed herpetic viral disease and subsequent nodular scleritis.
• Laboratory workup including HLA-B27 and infectious disease testing.
• Diagnostic anterior paracentesis with polymerase chain reaction (PCR) analysis of aqueous humor.
• Treatment with antivirals, corticosteroids, and immunosuppressants (methotrexate).

Main Results:

• The patient initially presented with anterior uveitis, successfully treated.
• Nodular scleritis developed, showing poor response to nonsteroidal anti-inflammatory drugs and incomplete response to oral prednisolone.
• PCR analysis of aqueous humor confirmed VZV infection.
• Treatment with valacyclovir and methotrexate led to clinical resolution of scleritis, allowing prednisolone withdrawal.

Conclusions:

• Anterior nodular scleritis can be caused by VZV, suggesting an underlying immune-mediated process.
• Immunosuppressive therapy is often necessary for complete resolution.
• PCR analysis of aqueous humor is a valuable diagnostic tool for refractory scleritis cases.