Nodular posterior scleritis mimicking choroidal metastasis: a report of two cases

Abstract

Posterior scleritis is a rare underdiagnosed condition that can potentially cause blindness. Its varied presentations lead to delayed or incorrect treatment. We present here the cases of two patients with nodular posterior scleritis mimicking a choroidal metastasis. Two female patients presented with a sudden unilateral visual loss associated with ocular pain. Fundus examination revealed temporomacular choroidal masses with exudative detachments that, due to angiographic presentation, were suggestive of choroidal metastasis. Systemic examinations were unremarkable. In the two cases, a local or general anti-inflammatory treatment led to the complete recovery of the lesions, which were, thus, considered nodular posterior scleritis. The diagnosis of nodular posterior scleritis has to be evoked in all patients presenting with a choroidal mass in fundus examination. It represents the principal curable differential diagnosis of malignant choroidal tumor.

Nodular Posterior Scleritis Mimicking Choroidal Tumor in a Patient With Systemic Lupus Erythematous

“…[5][6][7][8][9][10][11] One patient received topical steroids and multiple periocular triamcinolone (40 mg/mL) injections. 3 The response was good, with complete disappearance of the fundal mass and improvement in symptoms.…”

“…Fluorescence angiography using half-dose fluorescence showed heterogeneous hyperfluorescence in the early and late phases (Figs. 4,5). Repeated OCT revealed a less-elevated retina, and the mass had become smaller, situated temporal to the fovea with no serous retinal detachment (Fig.…”

A case of giant nodular posterior scleritis mimicking choroidal malignancy

“…also reported two cases of nodular posterior scleritis mimicking choroidal metastasis. [ 4 ] Differentiating between them remains a diagnostic challenge. Failure to make the correct diagnosis could lead to misguided treatment.…”

“…Nodular posterior scleritis can be treated by a variety of agents including the use of corticosteroid and nonsteroidal anti-inflammatory agents. [ 4 8 9 ] McCluskey et al . used systemic corticosteroids and immunosuppressive therapy when the posterior scleritis involved the optic nerve or was associated systemic diseases.…”

A case of nodular posterior scleritis mimicking choroidal mass

“…The inflammation may affect the whole sclera (diffuse posterior scleritis) or only a part of it (nodular posterior scleritis) 1–4 . Nodular posterior scleritis is more complex than the diffuse form, because it usually simulates a choroidal mass which may lead the physician to misdiagnosis and unwarranted surgeries 3–6 . In this case report we aimed to present a patient with nodular posterior scleritis mimicking a choroidal mass, and who was treated successfully with topical and systemic non-steroidal anti-inflammatory drugs.…”