Episcleritis as the primary clinical manifestation in a patient with polyarteritis nodosa.

PURPOSE To alert ophthalmologists to ocular manifestations that could indicate polyarteritis nodosa. CASE A 71-year-old man exhibited unilateral episcleritis as the primary clinical manifestation of polyarteritis nodosa. OBSERVATIONS The patient's ocular symptoms did not respond well to either topical betamethasone eye drops or low-dose oral prednisone. Five months after the onset of ocular symptoms, the patient progressively developed fever, pneumonia, and renal dysfunction. Positive antineutrophil cytoplasmic antibody indicated polyarteritis nodosa as the underlying systemic disease. Intravenous methylprednisolone (1 g/day) was started; however, the patient succumbed 10 days later after intracranial hemorrhage. CONCLUSIONS Ophthalmologists should be aware that such a common ocular manifestation as episcleritis can be the initial manifestation of polyarteritis nodosa and that its early diagnosis can reduce mortality from this disease.