Metastatic conjunctival squamous cell carcinoma presenting as infectious sclerokeratouveitis

Abstract

Purpose: We describe a case of metastatic conjunctival squamous cell carcinoma (SCC) presenting as an infectious sclerokeratouveitis in a patient with autoimmune disease. Observations: A 63-year-old Caucasian female presented to the cornea service with a raised perilimbal scleral infiltrate, hypopyon, and corneal perforation concerning for infectious necrotizing sclerokeratoveitis. She had an ocular history of a recurrent “pyogenic granuloma” and her medical history was notable for well-controlled systemic lupus erythematosus and rheumatoid arthritis. Scleral debridement and repair with a corneal patch graft was performed. Bacterial cultures grew 4+ Proteus mirabilis sensitive to tobramycin. One month later, she developed bulky painless scleral lesions with leukoplakic features. A scleral biopsy revealed squamous cell carcinoma. Imaging suggested ciliary body and medial rectus infiltration without perineural invasion. Right anterior exenteration was performed as immunotherapy was felt to be unlikely to achieve success in light of her autoimmune conditions. Six months later, she developed a palpable right parotid mass with biopsy confirming metastatic squamous cell carcinoma. She underwent a right parotidectomy and is now undergoing consolidative radiotherapy. Conclusions and Importance: Ocular surface neoplasia can present as a necrotizing sclerokeratouveitis, contributed by both the tumor and an atypical infectious process. Malignancy with superinfection should be in the differential diagnosis of recurrent ocular surface inflammation.

Keywords

• Ocular surface squamous neoplasia
• Conjunctival squamous cell carcinoma
• Sclerokeratitis
• Pyogenic granuloma
• Exenteration