Cryptococcal scleritis mimicking scleromalacia perforans

Scleromalacia perforans is a rare, non-inflammatory type of anterior scleritis that usually signals an underlying autoimmune disorder. However, certain infectious pathogens can mimic this clinical presentation which often leads to diagnostic difficulty. We describe a rare case of primary cryptococcal scleritis in an elderly man with diabetes who showed no evidence of systemic cryptococcal disease. He initially presented with progressive scleral thinning and minimal pain, which was interpreted initially as scleromalacia perforans.But surgical intervention with scleral patch grafting revealed Cryptococcus species on histopathology. Timely initiation of antifungal therapy led to visual improvement and clinical recovery. This case highlights the need for considering infectious causes, including rare fungal pathogens, in atypical or non-resolving scleritis and signifies the diagnostic importance of tissue biopsy.