Psoriasis-associated progressive necrotizing posterior scleritis: A 6-year follow-up

Purpose: Posterior scleritis is the least frequent form of scleritis accounting for around 2%–8% of all scleritis cases. We aim to present the 6-year clinical course of a 62-year-old female patient with bilateral progressive necrotizing posterior scleritis who suffered from concurrent active psoriasis and psoriatic arthritis. Methods: Descriptive case report. Results: A middle-aged female patient was referred to our clinic because of left eye peripheral progressively enlarging white retinochoroidal lesions. Her previous work-up ruled out infectious and malignant etiologies. A second diagnostic vitrectomy was performed because of the slowly progressive and the atypical nature of the sectoral retinochoroidal patches in the retinal periphery. Again malignancy was ruled out. With the onset of cystoid macular edema and diffuse retinal vasculitis, which occurred concurrently with the reactivation of psoriasis and psoriatic arthritis, treatment was initiated with systemic immunosuppressants which initially included oral steroids and methotrexate and at the last follow-up 6 years after the first presentation included also cyclosporin and golimumab. Vision was preserved with quiescent uveitis and posterior scleritis. Conclusion: Posterior scleritis is an uncommon condition and it is even rarer in the setting of psoriasis. The necrotizing inflammation observed in the present case and by others revealed sectoral progressive chorioretinitis as a clinical manifestation which may initially raise the suspicion of masquerade malignant and infectious etiologies. Detailed thorough history-taking remains the cornerstone in identifying the possible systemic associations even when occult or subclinical.