Wegener’s granulomatosis (WG) is a necrotizing
granulomatous inflammation. A 40-year-old lady
of Malay descent presented with unresolving
bilateral painful red eyes for three weeks. Clinical
examination revealed that best corrected vision
acuity of 6/9 for both eyes. Slit lamp examination
revealed diffuse scleritis. Other Investigations
result like UFEME blood cell: 2+, C-reactive
protein 70.06 mg/L and ESR of 125 mm/h
suggestive on acute inflammations. Connective
tissue screening revealed cytoplasmic ANCA
was positive and was supported by Anti-Serine
Protease3 (PR3) 68. All the investigation results
revealed that she had Wegener’s granulomatosis
with ophthalmology manifestation in the
form scleritis. Patient was treated with guttae
Maxidex QID to reduce cells that present in
anterior chamber and oral ibuprofen 400 mg
thrice daily. Subsequently, oral prednisolone
and oral cyclophosphamide with oral Bactrim
were commenced. Patient responded well and
redness resolved. There are many differential
diagnoses for chronic conjunctivitis but to rule
out connective tissue disease should be one of the
primary differential diagnoses in young female.
Oral immunosuppressive and Trimethoprim/
Sufmethoxazole (Bactrim) were been found
beneficial and symptoms were resolved. Wegener’s
granulomatosis is a great mimicker as exemplified
in this case. This disease can be misdiagnosed and
maltreated as conjunctivitis. Thus, the authors
wish to emphasize that WG is one the differential
diagnoses that need to be considered in a person
with bilateral scleritis.