Granulomatosis With Polyangiitis (GPA) Presenting With Painless Scleritis and Ocular Hypertension: Case Report

TL;DR

A 67-year-old man with painless eye redness and high eye pressure was diagnosed with GPA, a type of vasculitis, and improved with standard treatment.

Contribution

This case highlights GPA as a rare cause of painless scleritis and elevated episcleral venous pressure.

Findings

The patient's ocular symptoms improved with systemic steroids and standard GPA therapy.

MRI and cerebral angiogram showed no abnormalities, but rheumatologic testing confirmed GPA.

Painless scleritis and elevated episcleral venous pressure can be early signs of GPA.

Abstract

This case report describes a 67-year-old male who presented with a 2-month history of painless left eye redness and muffled hearing. Ophthalmologic examination revealed elevated intraocular pressure (IOP) and significant conjunctival injection without associated pain or visual disturbance. Blood was observed in Schlemm's canal (SC), and a thorough investigation for elevated episcleral venous pressure (EVP) was performed. Imaging, including magnetic resonance imaging (MRI) and cerebral angiogram, was unremarkable. A rheumatologic workup led to the diagnosis of granulomatosis with polyangiitis (GPA). The patient's ocular symptoms improved significantly with systemic steroid treatment. He was subsequently managed with rituximab and avacopan as per standard GPA therapy. This case highlights the importance of considering vasculitis in patients presenting with unexplained elevation of EVP, and painless scleritis, particularly when there are also extraocular complaints.

Figures