title: Masquerade scleritis.
abstract: OBJECTIVE
  To report two cases in which malignancy masqueraded as scleritis, delaying the diagnosis.
  
  
  METHODS
  Two patients initially diagnosed and treated for unilateral scleritis were referred for management of persistent inflammation. Additional evaluation uncovered underlying malignant processes.
  
  
  RESULTS
  The first patient presented with scleritis initially responsive to systemic corticosteroids, with relapse one month later. Upon referral, peripheral fundus examination revealed elevated lesions. Additional studies confirmed the diagnosis of choroidal melanoma. The patient was treated with proton-beam irradiation. The second patient developed necrotizing scleritis unresponsive to systemic steroids, methotrexate, and cyclophosphamide. A scleral biopsy disclosed an undifferentiated high-grade carcinoma, likely metastatic. Exenteration was performed.
  
  
  CONCLUSIONS
  Scleritis can present a diagnostic challenge. It is often the sole initial manifestation of an occult systemic problem. Treatment-resistant scleritis should raise the suspicion of an infectious or malignant masquerade.
authors.affiliation: Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Kafkala
authors.forename: Yassine J
authors.initials: YJ
authors.lastname: Daoud
authors.forename: Ian
authors.initials: I
authors.lastname: Paredes
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D001706:Biopsy; D002830:Choroid Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000532:radiotherapy; D012590:Sclera / Q000473:pathology; D015423:Scleritis / Q000175:diagnosis*