Refractory Nodular Scleritis as a Presenting Sign of Colorectal Cancer

Area of Science:

• Ophthalmology
• Gastroenterology
• Oncology

Background:

• Scleritis, an inflammatory eye condition, can be challenging to manage, particularly when recurrent.
• Paraneoplastic syndromes, immune responses to cancer, can manifest in various organs, including the eyes.

Observation:

• A 47-year-old female with a history of acute lymphoblastic leukemia presented with recurrent anterior nodular scleritis.
• Despite immunosuppressive therapy, the patient experienced monthly episodes of scleritis, prompting a systemic investigation.
• Diagnostic work-up revealed iron deficiency anemia and an ulcerovegetative mass in the colon.

Findings:

• The colonic mass was diagnosed as mucinous adenocarcinoma.
• Surgical resection of the colorectal cancer led to the complete resolution of scleritis.
• This suggests a paraneoplastic etiology for the patient's ocular inflammation.

Implications:

• This case underscores the critical need to consider paraneoplastic syndromes in the differential diagnosis of refractory or recurrent scleritis.
• Early identification and management of underlying malignancies, such as colorectal cancer, are crucial for resolving associated ocular manifestations.
• A multidisciplinary approach is essential for diagnosing and managing complex cases involving systemic disease and ocular inflammation.