A 55-year-old healthy man presented with redness and pain in both eyes and was diagnosed with bilateral scleritis. A year later impairment of ocular movement and cervical adenopathy appeared. Laboratory tests revealed signs of inflammation: increased erythrocyte sedimentation rate, lymphocytosis, lactate dehydrogenase, S-ACE converting enzyme and interleukin-2-antibody. An orbital MR-scan revealed inflammation of the extra-ocular muscles. PET-CT showed vascular changes consistent with vasculitis. Lymph node biopsy confirmed the diagnosis chronic lymphatic leukaemia (CLL). This is a rare case - presentation of bilateral scleritis in a patient with undiagnosed CLL, increased inflammatory markers and vasculitis - a possible ocular manifestation of a paraneoplastic syndrome.
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