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Case Reports in Ophthalmological Medicine
Volume 2016 (2016), Article ID 8519394, 3 pages
Case Report

Nodular Scleritis Associated with Herpes Zoster Virus: An Infectious and Immune-Mediated Process

1Vila Nova de Gaia/Espinho Hospitalar Center, R. Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal
2Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal

Received 29 February 2016; Accepted 26 April 2016

Academic Editor: Cristiano Giusti

Copyright © 2016 Mónica Loureiro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. To describe a case of anterior nodular scleritis, preceded by an anterior hypertensive uveitis, which was primarily caused by varicella zoster virus (VZV). Case Report. A 54-year-old woman presented with anterior uveitis of the right eye presumably caused by herpetic viral disease and was successfully treated. Two months later, she developed a nodular scleritis and started oral nonsteroidal anti-inflammatory without effect. A complete laboratory workup revealed positivity for HLA-B27; the infectious workup was negative. Therapy was changed to oral prednisolone and an incomplete improvement occurred. Therefore, a diagnostic anterior paracentesis was performed and the polymerase chain reaction (PCR) analysis revealed VZV. She was treated with valacyclovir and the oral prednisolone began to decrease; however, a marked worsening of the scleritis occurred with the reduction of the daily dose; subsequently, methotrexate was introduced allowing the suspension of the prednisolone and led to clinical resolution of the scleritis. Conclusion. This report of anterior nodular scleritis caused by VZV argues in favor of an underlying immune-mediated component, requiring immunosuppressive therapy for clinical resolution. The PCR analysis of the aqueous humor was revealed to be a valuable technique and should be considered in cases of scleritis with poor response to treatment.