Pseudomonas aeruginosa scleritis initially presenting as idiopathic diffuse anterior scleritis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Pseudomonas aeruginosa (P. aeruginosa) is a frequent cause of bacterial scleritis.
• Scleritis can present with varied clinical manifestations, sometimes mimicking other inflammatory conditions.

Purpose of the Study:

• To describe an atypical presentation of P. aeruginosa scleritis.
• To highlight the diagnostic challenges and treatment outcomes in such cases.

Main Methods:

• Case report of a patient with presumed sterile scleritis initially treated with corticosteroids.
• Clinical observation of disease progression, including nodule formation.
• Microbiological culture of nodule aspirate to identify the causative pathogen.
• Treatment with targeted antimicrobial therapy.

Main Results:

• The patient initially presented with diffuse anterior scleritis and uveitis, with negative laboratory work-up.
• High-dose oral corticosteroids worsened the condition, leading to nodule formation within 3 days.
• Nodule aspirate confirmed P. aeruginosa infection.
• Scleral inflammation resolved following appropriate antimicrobial treatment.

Conclusions:

• Pseudomonas aeruginosa can present atypically, challenging initial diagnosis.
• Corticosteroid therapy may exacerbate P. aeruginosa scleritis.
• Early microbiological diagnosis and targeted antimicrobial therapy are essential for successful treatment of P. aeruginosa scleritis.