Bilateral Nodular Scleritis, Anterior Uveitis, Interstitial Keratitis, and Outer Retinal Atrophy in Lepromatous...

To describe a case of biopsy-proven lepromatous leprosy and the associated ocular manifestations.

Case report of a patient seen at the Sue Anschutz-Rodgers Eye Center at the University of Colorado, Aurora, CO.

A 30-year-old male from Guam presented with chronic bilateral eye redness and decreased vision. Initial exam was notable for bilateral nodular scleritis, interstitial keratitis, and granulomatous anterior uveitis. Posterior segment findings included pigment sheathing of retinal vessels and loss of outer retina in the parafoveal macula on OCT. This patient also presented with systemic findings including erythematous papules and plaques on his face and lower extremities. Skin biopsy showed extensive infiltrating granulomatous inflammation with numerous acid-fast bacillus consistent with a diagnosis of erythema nodosum leprosum (ENL). He was subsequently treated with topical and systemic steroids, triple therapy consisting of rifampin, minocycline, and moxifloxacin, and low dose methotrexate. The patient's ocular inflammation improved significantly with resolution of his bilateral anterior uveitis and interstitial keratitis, and reduction in size of scleroconjunctival nodules within weeks of initiating therapy. However, posterior findings remained unchanged following treatment.

Leprosy can cause scleritis, anterior uveitis, and interstitial keratitis that respond well to triple therapy, topical and systemic steroids. This case highlights the importance of recognizing ocular manifestations of leprosy, which may result from direct bacillary infiltration or immune-mediated mechanisms.