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Posterior scleritis: an ominous sign of occult Takayasu’s arteritis
  1. Radgonde Amer1,
  2. Rosslyn Rankin2,
  3. James MacKenzie3,
  4. John Olson4
  1. 1
    Department of Ophthalmology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
  2. 2
    Department of Pathology, Raigmore Hospital, Inverness, Scotland, UK
  3. 3
    Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
  4. 4
    Department of Ophthalmic Medicine, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
  1. Dr Radgonde Amer, Department of Ophthalmology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZD, Scotland, UK; radgonde.amer{at}abdn.ac.uk

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Takayasu’s arteritis is a rare chronic obliterative vasculitis affecting the aorta and its major branches. Epidemiologically it is found mainly in females of reproductive age and is more prevalent in Asian and Latin American countries. Although the pathogenesis has not been entirely elucidated, Takayasu’s arteritis (TA) is considered to be a T-cell mediated granulomatous vasculitis.1

We herein report the case of a patient who presented with posterior scleritis that proved to be the only clinical manifestation of a fatal case of TA.

Case report

A 26-year-old healthy male Caucasian patient was referred to the Department of Ophthalmology of Aberdeen Royal Infirmary because of blurred vision, painful red eyes and photophobia. For 20 months prior to presentation he was treated with intermittent topical steroids and NSAIDS because of bilateral refractory steroid-dependent episcleritis. On examination visual acuity was 6/6 OD and 6/24 OS. Pupils were poorly reactive to light and no afferent pupillary defect was detected. He had significant episcleral injection bilaterally, but no signs of anterior uveitis were seen. Fundoscopy revealed a swollen right optic disc with choroidal folds in the posterior poles of both eyes (fig 1). B-scan echography revealed significant diffuse scleral thickening around the optic nerve extending to the extraocular muscle insertions with widening of Tenon’s space. The patient was thus diagnosed to have posterior …

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