PMC5253164_01
Color photograph of the superior bulbar area showing the area of inflammation before (a) and after (b) 5 weeks of treatment. Anterior segment ocular computerized tomography showing a thickened sclera and episclera with hyporeflective areas (asterisks) before treatment (c).
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Anterior segment ocular computerized tomography (OCT) demonstrated a thickened episclera and sclera with hyporeflective areas representing fluid in the region, confirming the diagnosis of scleritis (Figures 1(a) and 1(c)). Treatment with corticosteroids and a steroid-sparing agent (methotrexate) led to significant improvement in signs and symptoms, with the inflammation and swelling having almost completely subsided after 5 weeks of treatment (Figure 1(b)).
Histological Findings. (a) Hematoxylin-eosin stain at low-power field showing a marked lymphocytic plasmatic infiltrate. (b) Immunohistochemistry study for IgG. (c) Immunohistochemistry study for CD4. (d) Immunohistochemistry study of the same area demonstrating a diffuse pattern of IgG4-positive cells: a high proportion of the plasma cells are positive for IgG4 (~40%). (e) Immunohistochemistry study for CD4 cells at high-power field. (f) Immunohistochemistry study at high-power field showing >30 IgG4-positive cells per field.
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A large number of CD4+ positive cells (~50%) were observed in the specimen (Figures 2(a)-2(f)).