Refractory Nodular Scleritis as a Presenting Sign of Colorectal Cancer.

PURPOSE: To describe a rare case of recurrent anterior nodular scleritis as the initial manifestation of paraneoplastic syndrome in a patient with colorectal cancer.

METHODS

A case report of a 47-year-old female with a history of acute lymphoblastic leukemia who presented with ocular pain, redness, and blurred vision in her right eye. Despite treatment with corticosteroids and methotrexate, the patient experienced monthly recurrences of scleritis. A comprehensive work-up was conducted to investigate the underlying systemic disease.

RESULTS

Laboratory investigations revealed iron deficiency anemia and elevated inflammatory markers. Abdominal CT, followed by colonoscopy, revealed an ulcerovegetative mass at the splenic flexure. The patient underwent a left hemicolectomy. Pathological examination of the resected specimen confirmed the diagnosis of a mucinous adenocarcinoma. No recurrence of scleritis was observed after surgery.

CONCLUSION

This case highlights the importance of considering paraneoplastic syndrome in the differential diagnosis of unexplained or refractory scleritis, especially in elderly patients. A multidisciplinary diagnostic approach is essential to identify and manage such paraneoplastic manifestations.