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Nodular posterior scleritis - The great masquerader.

Naresh Babu¹, Karthik Kumar¹, Anubhav Upadhayay¹

¹Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

Taiwan Journal of Ophthalmology

|January 24, 2022

Summary

Nodular posterior scleritis (NPS) can mimic amelanotic choroidal melanoma, presenting a diagnostic challenge. Prompt treatment with oral steroids led to complete regression of the choroidal mass and exudative retinal detachment in this case.

Keywords:

Amelanotic melanoma choroidal mass diagnostic dilemma magnetic resonance imaging posterior scleritis pseudomelanoma

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Area of Science:

Ophthalmology
Medical Imaging
Pathology

Background:

Choroidal masses can present diagnostic challenges, particularly when mimicking amelanotic choroidal melanoma.
Accurate diagnosis is crucial for appropriate management and visual prognosis.

Observation:

A 57-year-old male presented with vision defects and periocular pain.
Ophthalmic examination revealed a subretinal mass with exudative retinal detachment.
MRI and ultrasonography showed a large choroidal mass with specific imaging characteristics.

Findings:

The patient was diagnosed with nodular posterior scleritis (NPS) with exudative retinal detachment.
The choroidal mass demonstrated atypical MRI features (T1 hyperintense, T2 hypointense).
Complete regression of the lesion was achieved with oral steroid therapy.

Implications:

Nodular posterior scleritis should be considered in the differential diagnosis of amelanotic choroidal masses.
Atypical imaging findings can complicate the diagnosis of choroidal lesions.
Early recognition and treatment of NPS can lead to favorable outcomes.