Purpose: To describe a case of severe scleritis with uveitis as the initial presentation of underlying eosinophilic granulomatosis with polyangiitis. Methods: Case report from a university ophthalmology clinic describing ocular findings, diagnostic workup, and treatment. Results: A 75-year-old woman presenting with severe anterior scleritis and panuveitis was initially misdiagnosed and treated for presumed infectious scleritis for 1 month without improvement. Further workup revealed elevated perinuclear anti-neutrophil cytoplasmic antibodies, supporting a diagnosis of eosinophilic granulomatosis with polyangiitis. Prompt initiation of high-dose oral corticosteroids led to rapid resolution of ocular inflammation. Conclusions: Severe scleritis with uveitis can be the first manifestation of occult eosinophilic granulomatosis with polyangiitis. A high index of suspicion for underlying autoimmune disease and timely rheumatologic workup are essential for accurate diagnosis. Early systemic immunosuppressive therapy is critical to optimize visual outcomes and prevent irreversible ocular damage.
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