# Anterior scleritis with IgG4 lymphoplasmacytic infiltration: a case report

## TL;DR

A rare case of eye inflammation was linked to IgG4-related disease, highlighting its importance in diagnosing similar conditions.

## Contribution

This case report presents a rare isolated presentation of IgG4-related disease as nodular anterior scleritis.

## Key findings

- The patient had chronic unilateral nodular anterior scleritis with partial response to treatment.
- Histopathology confirmed IgG4 lymphoplasmacytic infiltration in the scleral tissue.
- Scleritis can be a rare initial sign of IgG4-related disease.

## Abstract

To report a case of chronic unilateral nodular anterior scleritis as a rare, isolated presentation of IgG4-related ophthalmic disease.

A fifty-two-year-old patient was evaluated for painful, nodular scleral injection of the right eye, diagnosed as nodular anterior scleritis. There was only a partial response to topical corticosteroid and systemic immunomodulatory therapy. This, in combination with a sharp delineation between normal and abnormal sclera lead to the decision to perform a diagnostic biopsy of the lesion. Histopathology showed an IgG4 lymphoplasmacytic infiltration of the scleral tissue.

There are few documented reports of scleritis as the presenting manifestation of IgG4-related disease. IgG4-related disease is an increasingly recognized etiology to be considered in evaluating and managing scleritis.