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Successful treatment of refractory anterior scleritis in primary Sjögren’s syndrome with rituximab

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Anterior scleritis is an inflammation of the superficial, subconjunctival sclera which may follow infection or occur in rheumatic disease. Anterior scleritis due to secondary immune complex mediated vasculitis is an extremely rare extraglandular manifestation in primary Sjögren’s syndrome.1 Symptoms of anterior scleritis are pain, tearing, and photophobia. If left untreated, anterior scleritis may progress to scleromalacia and, ultimately, threaten eyesight by affecting the uvea.2 Here we report on the successful induction of remission with the B cell directed monoclonal anti-CD20 antibody in a case of refractory anterior scleritis with episcleritis in primary Sjögren’s syndrome.

CASE REPORT

Primary Sjögren’s syndrome was diagnosed in a 60 year old white woman according to the criteria of the European study group.3 Ocular and oral sicca symptoms included for more than 3 months, a pathological Schirmer test (<5 mm/5 min), and pathological salivary scintigraphy. Antinuclear antibodies and Ro (SSA) were detected and, later on, anti-fodrin antibodies. Complement levels were normal, cryoglobulin was negative. The patient was treated for arthralgia with low dose steroids and hydroxychloroquine.

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