A Case of Posterior Scleritis with Negative Rheumatoid Factor and Positive Anti-Cyclic Citrullinated Peptide Antibody Status: Case Report
Keywords:
Scleritis, Rheumatoid Arthritis, Anti-CCP, Case reportAbstract
Background: Posterior scleritis is a potentially vision threatening condition which is often underdiagnosed due to varied clinical presentation, several non-infectious inflammatory diseases can cause this disorder, although infectious diseases should be ruled out.
Case presentation: A 56 years-old-female with acute unilateral decreased vision in right eye and positive history for rheumatoid arthritis (RA) was referred, based on ophthalmic examination the diagnosis of posterior scleritis was considered. The only positive inflammatory marker was found is high serum titer of Anti-Cyclic Citrullinated Peptide (Anti-CCP).
Conclusion: This is the first case of posterior scleritis with only positive Anti-CCP. Elevated serum Anti-CCP titer may be considered as risk factor for inflammatory scleritis in patient with RA.
References
Watson P, Hazleman BL, Pavésio C, Green WR (2004) Sclera and systemic disorders, 2nd edn. Oxford, Butterworth Heinemann.
Jabs DA, Mudun A, Dunn JP, Marsh MJ. Episcleritis and scleritis: clinical features and treatment results. American journal of ophthalmology. 2000;130(4):469-76. https://doi.org/10.1016/S0002-9394(00)00710-8
PMid:11024419
Falkenburg WJ, van Schaardenburg D, Ooijevaar-de Heer P, Wolbink G, Rispens T. IgG Subclass Specificity Discriminates Restricted IgM Rheumatoid Factor Responses From More Mature Anti-Citrullinated Protein Antibody-Associated or Isotype-Switched IgA Responses. Arthritis & rheumatology (Hoboken, NJ). 2015;67(12):3124-34. https://doi.org/10.1002/art.39299 PMid:26246004
McCluskey PJ, Watson PG, Lightman S, Haybittle J, Restori M, Branley M. Posterior scleritis: clinical features, systemic associations, and outcome in a large series of patients. Ophthalmology. 1999;106(12):2380-6 https://doi.org/10.1016/S0161-6420(99)90543-2 PMid:10599675
Edkins A CW. The Jekyll and Hyde nature of antibodies Biological Sciences Review. 2012;2(4):25.
Alunno A, Bistoni O, Pratesi F, Topini F, Puxeddu I, Valentini V, et al. Association between anti-citrullinated alpha enolase antibodies and clinical features in a cohort of patients with rheumatoid arthritis: a pilot study. Reumatismo. 2018;70(2):67-71. https://doi.org/10.4081/reumatismo.2018.1028 PMid:29976039
Puszczewicz M, Iwaszkiewicz C. Role of anti-citrullinated protein antibodies in diagnosis and prognosis of rheumatoid arthritis. Archives of medical science : AMS. 2011;7(2):189-94. https://doi.org/10.5114/aoms.2011.22067 PMid:22291756 PMCid:PMC3258718
El-Banna H, Jiman-Fatani A. Anti-cyclic citrullinated peptide antibodies and paraoxonase-1 polymorphism in rheumatoid arthritis. BMC musculoskeletal disorders. 2014;15:379. https://doi.org/10.1186/1471-2474-15-379 PMid:25406539 PMCid:PMC4247608
Itty S, Pulido JS, Bakri SJ, Baratz KH, Matteson EL, Hodge DO. Anti-cyclic citrullinated peptide, rheumatoid factor, and ocular symptoms typical of rheumatoid arthritis. Transactions of the American Ophthalmological Society. 2008;106:75-81; discussion -3.
Bhamra MS, Gondal I, Amarnani A, Betesh S, Zhyvotovska A, Scott W, et al. Ocular Manifestations of Rheumatoid Arthritis: Implications of Recent Clinical Trials. International journal of clinical research & trials. 2019;4(2). https://doi.org/10.15344/2456-8007/2019/139
Maggioni F, Ruffatti S, Viaro F, Mainardi F, Lisotto C, Zanchin G. A case of posterior scleritis: differential diagnosis of ocular pain. The journal of headache and pain. 2007;8(2):123-6 https://doi.org/10.1007/s10194-007-0372-0 PMid:17497266 PMCid:PMC3476131
Keino H, Watanabe T, Taki W, Nakashima C, Okada AA. Clinical features and visual outcomes of Japanese patients with scleritis. The British journal of ophthalmology. 2010;94(11):1459-63. https://doi.org/10.1136/bjo.2009.171744 PMid:20576778
Agarwal AM, Dutta Majumder P. Tubercular posterior scleritis: A case report and review of literature. Indian journal of ophthalmology. 2019;67(8):1362-5 https://doi.org/10.4103/ijo.IJO_1942_18 PMid:31332144 PMCid:PMC6677048
Che X, Jiang J, Qian Y, Li Q, Zhang Y, Wang Z. Case report-immune recovery posterior scleritis in a HIV positive patient. 2020;20(1):262. https://doi.org/10.1186/s12886-020-01529-3 PMid:32615955 PMCid:PMC7330949
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