Scleral perforation in a young adult with Burkitt lymphoma.
Orsolya Bálint, Eva Suranyi, Yi-Che Chang Chien et al.
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Case in brief
A man in his 20s with Burkitt lymphoma receiving chemotherapy was referred for lagophthalmos and left facial nerve palsy. Weeks later, he developed acute scleral perforation. Surgical closure was followed by severe corneal thinning to Descemet membrane, iris adherence to the endothelium and progressive scleral expansion. Further reconstruction was not feasible, and the eye was enucleated. Histopathology showed keratoconjunctivitis and acute perforative scleritis, but did not establish the cause. Review of his medical records identified Pseudomonas aeruginosa bacteraemia, considered a possible underlying cause of the ocular disease.
What made this case unusual
The case describes scleral perforation without prior ocular surgery in a patient with P. aeruginosa bacteraemia; the authors note that this presentation had not previously been reported.
Diagnostic / clinical pearl
In acute perforative scleritis, review of systemic records may reveal a relevant bacteraemia even when ocular histopathology does not establish the aetiology.