Anterior Scleritis in the Setting of Multiple Autoimmune Disorders: A Rare Case Report and Literature Review

Abstract Background: Scleritis is an uncommon inflammatory ocular disorder with heterogeneous etiologies. Although scleritis has occasionally been reported in association with Sjögren's syndrome and antiphospholipid syndrome, its occurrence in patients with multiple concomitant autoimmune diseases is exceedingly uncommon. This is also the first case suggesting a possible association between polymyositis and anterior scleritis. This case may serve as a useful reference for clinicians in managing similar conditions with multiple concomitant autoimmune diseases. Case presentation: A 65-year-old woman with long-standing polymyositis, Sjögren’s syndrome, and antiphospholipid syndrome developed severe left ocular pain following treatment for suspected polymyositis-related pulmonary hypertension with prednisolone and mycophenolate mofetil. Ophthalmic examination revealed mild ptosis, eyelid swelling, diffuse bulbar conjunctival injection with prominent corkscrew vessels, and superficial keratopathy in the left eye. A diagnosis of anterior scleritis was made. Initial treatment with topical fluorometholone and supportive therapy resulted in resolution of ocular pain and improvement of inflammation within one week. However, recurrence with superimposed conjunctivitis occurred one week later. Oral diclofenac, topical levofloxacin, frequent preservative-free artificial tears, and carbomer gel were subsequently administered. The ocular inflammation gradually resolved over three weeks. Conclusion: This case highlights a rare occurrence of anterior scleritis in the setting of multiple coexisting autoimmune diseases and suggests a potential association between polymyositis and scleritis that warrants further investigation. Scleritis may develop despite ongoing systemic immunosuppressive therapy, emphasizing the importance of prompt ophthalmic evaluation in patients with autoimmune diseases who develop ocular pain or inflammation.