Diffuse posterior scleritis associated with human leukocyte antigen-b14* managed with multimodal imaging: case report and review of the literature.

PURPOSE:To report a case of posterior scleritis in a human leukocyte antigen (HLA)-B*14-positive patient, highlighting the crucial role of multimodal imaging and of autoimmune systemic disease screening for the diagnosis. METHODS:Case report. RESULTS:A 73-year-old woman, complaining of ocular discomfort in right eye, presented conjunctival hyperemia, keratic precipitates involving the anterior segment and four chorioretinal elevations with macular folds at fundus examination. Multimodal imaging and systemic diagnostic workup were performed. While awaiting results, topical corticosteroid was prescribed. Four days later, worsening of exudative chorioretinal was detected. Except for erythrocyte sedimentation rate, tests were negative, whereas molecular typing of HLA genes was positive for HLA-B*14. Diagnosis of posterior scleritis was confirmed by ultrasound examination while diagnosis of ankylosing spondylitis was made by rheumatologist. The patient was given systemic corticosteroid, and one month later, the posterior segment was unremarkable. CONCLUSION:HLA-B*14 may configure as a causal factor, so autoimmune systemic disease screening should rule this out in the management of posterior scleritis, which should be diagnosed on the basis of multimodal imaging.