Case report peripheral ulcerative keratitis with nodular scleritis, presents as the primary manifestation of granulomatosis with polyangiitis.

Granulomatosis with polyangiitis (GPA) is an ANCA-associated autoimmune disorder that typically affects small and/or medium-sized blood vessels. Being a life-threatening disease, with timely suspicion, targeted laboratory investigations, and collaborative management from the ophthalmologist and rheumatologist led to long-term remission of the disease. Case: A 38-year-old female complaining of recurrent deep boring pain with redness in her left eye for many years, which was diagnosed as nodular scleritis with peripheral ulcerative keratitis. The patient also has recurrent bouts of epistaxis and in suspicion of GPA laboratory investigations were carried out and later diagnosed. She was started on cyclophosphamide and is currently under maintenance with rituximab. Case discussion: Ocular involvement has been shown to occur in 20-50% of the population in several studies. It causes conjunctivitis, episcleritis, scleritis, necrotizing keratitis, corneoscleral perforation, posterior uveitis, and optic neuritis. The positive C-ANCA and high PR3 autoantibody have high sensitivity and association with GPA. Cyclophosphamide has been shown to be an effective treatment in multiple studies whereas rituximab has been emerging as a new treatment modality for maintenance, which in turn helps in the remission and relapse of GPA cases. Conclusion: Scleritis and peripheral ulcerative keratitis can be the manifestation of a GPA. Careful evaluation, diagnosis, and management with a multidisciplinary medical team, early start of cyclophosphamide, and rituximab have a huge role in decreasing the disease activity and is life-saving.

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INTRODUCTION: Recently, the Indian subcontinent has been hard hit by the second wave of COVID-19. Along with it, the region has become a hot spot for mucormycosis infection in patients with COVID-19. The aim of this paper is to provide a scientific overview on the status of mucormycosis in pre-COVID-19 era and on how COVID-19 could have directly or indirectly expose the hidden burden of mucormycosis globally. MATERIALS AND METHODS: This paper is structured as a narrative review and is based on relevant published literature on both COVID-19 and mucormycosis. CONCLUSION: Mucormycosis in the pre-COVID-19 era was almost a neglected entity. It was because the risk factors for both - More severe COVID-19 infections and Mucormycosis are almost similar - COVID-19 might have helped to expose the true magnitude of the mucormycosis and flagging it as a major public health concern requiring a revisit by medical science.