IntroductionThe object of this case is to report the clinical findings, microbiological findings and management of a case of fungal scleritis following cataract surgery, which mimicked surgically induced necrotizing scleritis.Case presentationA 72-year-old Asian (Indian) man presented with scleritis following cataract surgery at another facility. He had been treated elsewhere for suspected scleritis, primarily with steroids followed by empiric antibiotic and antifungal agents. At our institute he underwent a complete microbiological workup and a scleral patch graft. The scleral scraping revealed fungal filaments. He was treated postoperatively with topical and systemic antifungal agent along with topical cyclosporine. The follow-up examination at 5 months revealed that the scleral patch graft was successful in maintaining the integrity of his globe and restoring partial vision.ConclusionsFungal scleritis may mimic surgically induced necrotizing scleritis. Early diagnosis and prompt management can prevent progression of the disease and further devastating complications.
Objectives. Interstitial lung disease (ILD) with features of pulmonary fibrosis and honey-combing is a significant cause of morbidity and mortality in patients with systemic sclerosis (SSc). High resolution computed tomography (HRCT) is the established non-invasive gold standard technique for the diagnosis of SSc related ILD. The present study was designed to characterise HRCT features of ILD in SSc and to correlate pulmonary function test (PFT) parameters with HRCT semi-quantitative scores.Methods. This is an observational, cross-sectional study including 36 patients of SSc who underwent HRCT chest. All the patients were females. Severity and extent were assessed using four HRCT features: ground-glass opacity (GGO), mixed GGO and reticular opacity, reticular fibrosis and honey-combing. Thirtythree patients were able to perform PFT. Total HRCT score, inflammatory index and fibrosis index were correlated with PFT parameters.Results. Interstitial lung disease was found in 33 patients (91.6%), 24 patients (66.6%) had mixed GGO along with reticular inter-lobular septal thickening. Majority of the patients (64%) had non-specific interstitial pneumonia (NSIP) pattern. Usual interstitial pneumonia (UIP) pattern was seen in 25% of the cases. One patient had overlapping features of both UIP and organising pneumonia. There was predominant lower lobe involvement. Among the 33 patients who were able to perform PFT, 85% had abnormal results (predicted forced vital capacity [FVC]<80%). Total HRCT score showed significant negative correlation with PFT parameters --FVC (r=-0.48, P=0.004) and forced expiratory volume in one second (FEV 1 ) (r=-0.28, P=0.1), respectively. The ratio of FEV 1 and FVC had significant positive correlation with total HRCT score (r=0.5, P=0.002). Inflammatory index and fibrosis index had significant negative correlation with predicted FVC% (P<0.05).Conclusions. Mixed pattern (GGO and reticular opacity) was the most common HRCT finding. HRCT semi-quantitative scoring system is sensitive in assessing the severity and extent of ILD qualitatively and quantitatively in SSc patients.
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