Bilateral Nodular Scleritis and Asymmetric Intraocular Inflammation in an Adolescent with Myelodysplastic Syndrome and Marasmus-Associated Sweet Syndrome: A Case Report

Abstract

Background: Ocular involvement in myelodysplastic syndrome (MDS)-associated Sweet syndrome is uncommon. Bilateral nodular scleritis with severe fibrinous anterior uveitis presents diagnostic and treatment challenges in an immunocompromised patient.

Objective: To describe the presentation and 30-day response to treatment in an adolescent with MDS-associated ocular Sweet syndrome.

Methods: This longitudinal case report documented visual acuity, slit-lamp findings, B-scan ultrasonography, laboratory results, and infection surveillance at baseline and on days 7, 14, and 30.

Results: A 16-year-old boy with MDS, marasmus, and prior tuberculosis developed bilateral nodular scleritis and severe right-eye fibrinous anterior uveitis. Baseline visual acuity was 1/300 in the right eye and 6/30 in the left. Following multidisciplinary assessment, he received oral methylprednisolone (0.8 mg/kg/day), topical dexamethasone, and prophylactic levofloxacin. By day 14, the pupillary membrane had cleared and scleral nodules had regressed. At day 30, visual acuity was 6/60 and 6/18, respectively, without observed tuberculosis reactivation or hepatotoxicity.

Conclusion: Coordinated corticosteroid treatment with close infectious and systemic surveillance was associated with sustained ocular improvement in this high-risk patient.

Discussion: The marked interocular asymmetry and sterile inflammatory findings emphasize the need to exclude infection before immunosuppression and to monitor systemic risks throughout treatment.