(BMJ)—A 37-yo woman w/ Raynaud phenomenon presented w/ a 2-wk hx of painful, red eyes. Exam: digital ulcers, skin tightening. Vision assessment: 20/20 bilaterally. Intraocular pressure WNL; redness on nasal side of sclera bilaterally, w/ dilated scleral/episcleral vessels; retinas normal. Labs: elevated CRP and erythrocyte sedimentation rate. ANA +. What is the dx?
Cutaneous systemic sclerosis
Systemic lupus erythematosus
Rheumatoid arthritis
Sarcoidosis
Buerger dz
You are correct. The pt had an equivocal Scl 70 antibody test, w/ other serologies all neg and a CT consistent w/ interstitial lung dz; she was diagnosed w/ diffuse cutaneous systemic sclerosis (scleroderma) w/ bilat nodular scleritis. Scleral involvement has been described w/ systemic autoimmune dz, but rarely w/ scleroderma. The pt was started on NSAIDs and oral steroids, w/ monthly cyclophosphamide. On f/u at 4wk, she had marked reduction in inflammation, w/ healing scleritis bilaterally. Early identification and tx can prevent complications/sequelae due to scleritis.

BMJ Case Reports CP 2020;13:e236042.