Bilateral Scleritis and Retinal Vasculitis in Microscopic Po
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A 63-year-old man reported progressively worsening ocular pain, redness, vision loss, malaise, and nocturia during the previous 1.5 months. A bilateral deep violaceous episcleral vessel injection was observed (Fig 1A, B). Fluorescein angiography showed sectorial leakage of medium-sized retinal arteries. Laboratory testing revealed high erythrocyte sedimentation rate, serum creatinine, and perinuclear anti-neutrophil cytoplasmic antibodies. Examination of a renal biopsy specimen revealed focal necrotizing glomerulonephritis with 25% crescents. A diagnosis of microscopic polyangiitis was made. Remission induction therapy with pulses of intravenous cyclophosphamide plus methylprednisolone was started and patient's systemic involvement related to severe anti-neutrophil cytoplasmic antibodies associated vasculitis completely resolved.

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