Scleromalacia perforans: a case report

Abstract

BackgroundScleromalacia perforans is a rare ocular manifestation of rheumatoid arthritis which can potentially lead to blindness and is a late consequence in the course of the disease. It is an unusual finding for it to be present in a patient with joint pain without any rheumatologic progression of disease.Case presentationWe describe a rare case of scleromalacia perforans and orbital inflammatory disease in a 40-year-old Pakistani woman with apparently no associated rheumatologic deformity. It is rare in the sense that we usually see scleromalacia perforans with fixed deformities of rheumatoid arthritis in the hands or progressed systemic complications but not as a starting landmark of disease. She presented to us with pronounced eye manifestation which on further inquiry and investigation was found to be associated with rheumatoid arthritis. There was perforation of left globe on presentation and the right one was preserved. She visited various physicians and ophthalmologists and was treated with topical and systemic antibiotics but ended up losing sight in her left eye.ConclusionWe conclude that ocular manifestations, however rare they are, should be foreseen, investigated, and treated in patients with suspected arthritis as the complication is grave and sight threatening.

Scleromalacia perforans as the presenting sign for rheumatoid arthritis — a case report

“…Although scleritis may be the initial sign of rheumatoid disease, it usually presents more than 10 years after the onset of arthritis. Multiple studies have found that patients with scleritis have more advanced joint disease and more extra-articular manifestations than do patients with rheumatoid arthritis without scleritis [7]. Although our patient did manifest a full-blown picture of rheumatoid arthritis, she was not diagnosed with the disease earlier, mainly due to neglect.…”