Tuberculous scleritis in a patient with rheumatoid arthritis

Ocul Immunol Inflamm. 2012 Feb;20(1):49-52. doi: 10.3109/09273948.2011.628195. Epub 2011 Dec 20.


Scleritis is an ocular inflammatory disorder commonly associated with systemic autoimmune diseases. We report a case of nodular scleritis with an etiological diagnosis of tuberculosis wherein diagnosis was possible only after histopathological examination of the enucleated eye.

Method of study: A 52 year female patient was referred as a case of nodular scleritis not responding to topical and oral anti-inflammatory agents. She was being treated with immunosuppressives for rheumatoid arthritis by her rheumatologist. Scleritis improved initially but worsened in few months with development of complications. Eye was enucleated and histopathological examination revealed tuberculous bacilli in retinal pigment epithelial cells.

Conclusion: Infective scleritis should be suspected in cases of scleritis which progress despite treatment. Reactivation of latent Mycobacterium tuberculosis may occur especially in patients on long term systemic immunosuppressive treatment. Early detection and aggressive treatment is necessary for preventing morbidity or mortality due to these infections.

Publication types

  • Case Reports
  • Letter

MeSH terms

  • Antitubercular Agents / therapeutic use
  • Arthritis, Rheumatoid / complications*
  • DNA, Bacterial / analysis
  • Diagnosis, Differential
  • Eye Enucleation
  • Female
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Mycobacterium tuberculosis / genetics
  • Mycobacterium tuberculosis / isolation & purification*
  • Polymerase Chain Reaction
  • Retinal Pigment Epithelium / microbiology*
  • Retinal Pigment Epithelium / pathology
  • Scleritis / etiology*
  • Scleritis / microbiology
  • Scleritis / therapy
  • Tuberculosis, Ocular / diagnosis
  • Tuberculosis, Ocular / etiology*
  • Tuberculosis, Ocular / therapy


  • Antitubercular Agents
  • DNA, Bacterial