Posterior localized nodular scleritis mimicking malignancy, a case report and clinical approach

Aim: To report a patient with choroidal bulging, sub-retinal fluid, and optic nerve head (ONH) swelling who was finally diagnosed with focal nodular posterior scleritis. Case report: A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started. Conclusion: Posterior scleritis is an uncommon inflammatory condition that could be misdiagnosed with choroidal tumors, posterior uveitis, and orbital inflammation.