Rev Bras Oftalmol.2026;85:e0085
Nodular scleritis and leukocytoclastic vasculitis: the dangerous association of propylthiouracil with ocular and cutaneous complications
DOI: 10.37039/1982.8551.20260085
ABSTRACT
As scleritis may represent the initial manifestation of systemic vasculitis, recognizing drug-related etiologies iscrucial — particularly propylthiouracil (PTU). This medication is widely used to treat Graves disease and can trigger antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This study aims to describe the clinical course and diagnostic reasoning of a case of nodular scleritis associated with PTU-induced leukocytoclastic vasculitis (LCV), emphasizing the importance of early identification. This case report is based on medical record review, ophthalmological examination, skin biopsy, and ANCA testing. The patient, a 30-year-old female patient on chronic PTU therapy presented with severe anterior nodular scleritis in the right eye, which progressed to painful cutaneous lesions compatible with systemic vasculitis. Laboratory evaluation revealed positive p-ANCA, and biopsy confirmed LCV. PTU was immediately discontinued, and supportive therapy was initiated, resulting in complete resolution of ocular and cutaneous symptoms within seven days, with no recurrence over six months. This case highlights that, in patients using PTU who present with scleritis, drug-induced AAV should be promptly considered, as medication withdrawal is crucial to prevent severe and potentially irreversible outcomes. Integrated care involving Ophthalmology, Dermatology, Endocrinology, and Rheumatology is critical for accurate diagnosis and adequate management of this rare but clinically significant condition.