Long-term remission of severe refractory scleritis associated with ulcerative colitis after proctocolectomy: a case report and literature review.

Extraintestinal manifestations occur in up to 50% of patients with inflammatory bowel disease and can affect various organs, including the joints, skin, and eyes. Scleritis, one such extraintestinal manifestation, is associated with severe eye pain, vision impairment, and potential permanent vision loss. However, it is rare, and detailed descriptions of its characteristics and management are limited. We report the case of a 55-year-old man initially diagnosed with proctitis ulcerative colitis who simultaneously developed scleritis as the disease progressed to left-sided colitis. Treatment with 5-aminosalicylic acid, systemic steroids, and thiopurines failed to prevent a gradual decline in vision. Neither tacrolimus nor infliximab induced remission of ulcerative colitis or scleritis. Ultimately, total proctocolectomy was performed to treat refractory colitis. After surgery, the scleritis resolved immediately. Remission has persisted for over 10 years without recurrence, despite discontinuation of all medications (including ophthalmic solutions). This is the first documented case of severe, intractable scleritis resolving after proctocolectomy, suggesting an intestinal-ocular interaction in the pathogenesis of ulcerative colitis.