Rheumatoid Arthritis-Associated Necrotizing Scleritis and Peripheral Ulcerative Keratitis Treated Successfully With Infliximab

Abstract

In Brief In patients with rheumatoid arthritis (RA), necrotizing scleritis, an ocular manifestation of a systemic vasculitic process, is associated with significant ocular morbidity and high mortality. We present a 60-year-old man with RA who developed necrotizing scleritis and peripheral ulcerative keratitis. The scleritis was refractory to local measures, systemic corticosteroids, and cyclophosphamide but responded rapidly to infliximab. Our case illustrates that biologic agents may be considered in refractory cases of sight- and life-threatening scleritis. Systemic corticosteroids and cyclophosphamide failed to correct this fulminating scleritis and keratitis. The patient responded dramatically to infliximab with methotrexate.