title: Scleritis as the initial clinical manifestation of graft-versus-host disease after allogenic bone marrow transplantation.
abstract: OBJECTIVE
  To describe a case of scleritis with choroidal detachment as the initial clinical manifestation of graft-versus-host disease after allogenic bone marrow transplantation.
  
  
  METHODS
  Interventional case report.
  
  
  METHODS
  Review of clinical records.
  
  
  RESULTS
  A 50-year-old man developed symptoms of mild dry eye syndrome 20 days after receiving a one-antigen-mismatched allogenic bone marrow transplant. Five days later, he developed orbital pain, moderate visual loss, and a sterile orbital abscess on the left side. The orbital inflammatory collection was drained, and symptoms improved. On day 41 after bone marrow transplantation, the patient developed severe ocular pain and scleral thickening with secondary choroidal detachment and glaucoma in the right eye. The patient had no systemic signs of graft-versus-host disease at this time. The ocular symptoms and signs responded remarkably well to intravenous corticosteroids. Six months after bone marrow transplantation, while receiving low-dose oral methylprednisolone, the patient developed a skin rash. A biopsy of the involved skin confirmed the diagnosis of graft-versus-host disease.
  
  
  CONCLUSIONS
  Scleritis can be the initial clinical manifestation of graft-versus-host disease after allogenic bone marrow transplantation.
authors.affiliation: Vitreoretinal Consultants, Houston, Texas, USA.
authors.forename: Rosa Y
authors.initials: RY
authors.lastname: Kim
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Aresu A
authors.initials: AA
authors.lastname: Naderi
authors.forename: Pettion
authors.initials: P
authors.lastname: Rivera
authors.forename: M Amir
authors.initials: MA
authors.lastname: Ahmadi
authors.forename: Bita
authors.initials: B
authors.lastname: Esmaeli
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D000068438:Brimonidine Tartrate; D015862:Choroid Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D004359:Drug Therapy, Combination; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D016399:Lymphoma, T-Cell / Q000628:therapy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011810:Quinoxalines / Q000627:therapeutic use; D015423:Scleritis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014184:Transplantation, Homologous
chemical_list: D011810:Quinoxalines; D000068438:Brimonidine Tartrate; D000086:Acetazolamide; D008775:Methylprednisolone