Nodular Scleritis In Crohn's Disease: A Case Report

Crohn's disease is a chronic inflammatory bowel disease (IBD) that evolves by relapses interspersed with remissions.

The presentation of the disease in children is typical in the majority of cases and is declared by digestive symptoms. However, there may be other atypical revelations of the disease, for example nodular scleritis which is a severe and necrotizing inflammation threatening vision. The purpose of our observation is to underline the importance of a meticulous initial ophthalmological examination in the assessment and early diagnosis of IBD and the importance of close collaboration between ophthalmologists and pediatricians in the early management of this type of disease.

We report the case of an 11-year-old boy with no previous history, who presented 3 days before admission with rapidly progressive bilateral eye pain with redness and photophobia.

The interrogation revealed that the patient had been suffering from digestive symptoms for 1 month, with abdominal pain associated with bloody diarrhea, mouth ulcers and arthralgia in a context of cachexia with fever.

The initial examination of each unit was unremarkable except for the presence of ano-perineal ridges on 240° from 1h to 8h.

The visual acuity of the right eye is 10/10, that of the left eye is 5/10 and not improvable. Biomicroscopic examination showed severe nodular scleritis and corneal ulceration  in both eyes. Intraocular pressure was 17 mmHg on the right and 13 mmHg on the left. Fundus examination was normal in both eyes.

The Crohn's disease origin of his symptomatology was raised and confirmed.

The patient was hospitalized for a complete clinical and biological etiological workup and to receive intravenous corticosteroid therapy with a bolus of methylprednisolone 500mg/day for three consecutive days, followed by oral corticosteroid therapy at a rate of 1 mg/kg per day of prednisone + adjuvant treatment.

The evolution under treatment was marked by an improvement of the digestive signs and disappearance of the ophthalmological damage.

The patient was seen again in the department one month later, while he was under 30mg per day of prednisone and immunosuppressive treatment based on Azathioprine, visual acuity was still stable, the biological check-up was normalized: negative VS

Eye  involvement in Crohn’s disease can take many different forms, all of which have a low prevalence but are nevertheless important to know. Exacerbations are considered to be a risk factor for ocular damage, especially during the first year of the disease in young patients.

Early diagnosis, close surveillance and proper management of the disease are therefore paramount to preserve the visual prognosis of these patients.