Presumed cocaine-induced posterior scleritis

Fig. 1: Multimodal imaging of a 51-year-old male with history of cocaine abuse who presented with left acute visual loss. Full size image Examination revealed bilateral ocular surface hyperaemia and globe tenderness. Fundoscopy showed left exudative retinal and choroidal detachment ( A ) with limited right-sided involvement (not shown). Structural OCT imaging showed left choroidal undulation with subretinal fluid ( B ). Fluorescein angiography demonstrated optic disc hyperfluorescence and peripheral dye leakage (C ). Ultrasound B-scan imaging showed posterior coat thickening and limited sub-Tenon’s fluid ( D ). Laboratory testing revealed neutrophilia with raised CRP and ESR levels, while serum immuno-fluorescence staining showed positive cytoplasmic anti-neutrophil cytoplasmic antibodies with undetectable anti-myeloperoxidase and anti-proteinase 3 titres. Systemic vasculitis was excluded, and a diagnosis of cocaine-induced vasculitis with bilateral anterior and posterior non-necrotizing scleritis was made. Treatment with intravenous methylprednisolone and oral prednisolone led to resolution of exudative changes. To our knowledge, this is the first report of scleral inflammation in the context of presumed cocaine-induced vasculitis.