Anterior scleritis treated with systemic corticosteroids in Chikungunya infection

BACKGROUND: Chikungunya is a matter of grave concern in Brazil. This case report describes a rare ocular manifestation in a patient with chikungunya. CASE REPORT: A 49-year old male diagnosed with chikungunya one month previously was being treated and followed up by a rheumatologist. He presented with complaints of pain and hyperemia in both eyes over the preceding seven days. Biomicroscopy of both eyes revealed bulbar conjunctival hyperemia 3+/4+ with 360° of ciliary injection, and no other abnormalities. The patient was prescribed 1 drop of loteprednol etabonate every 4 h, tapering every three days, and nimesulide 100 mg every 12 hours for 7 days. One week later, however, scleritis was worse and the medial sclera was elevated, particularly in the right eye. Intraocular pressure remained normal, and hyperemia increased to 4+/4+ in the right eye. Supplementary tests revealed positive serology for chikungunya IgG and IgM antibodies and other etiologies were ruled out. Treatment was then changed to oral prednisone 60 mg/day, tapering every three days. The patient was pain-free three days later with all signs and symptoms having disappeared within five days. CONCLUSION: Ocular abnormalities resulting from chikungunya virus infection require careful monitoring even after the acute phase of chikungunya infection has passed. The fact that patients usually stop being followed-up after they have been symptomless for some time delays diagnosis and the appropriate treatment of ocular manifestations. Consequently, chikungunya should be included in the differential diagnosis of ocular pathologies wherever the infection is endemic or epidemic.