When workup revealed a positive Quantiferon-TB Gold test result (Cellestis Inc, Valencia, California) and calcified granulomas in bilateral hila on chest radiography and chest computed tomography, the patient was referred to the infectious disease service and began treatment with quadruple antituberculosis therapy (rifampin, isoniazid, pyrazinamide, and ethambutol hydrochloride). Methotrexate was stopped, and she self-discontinued prednisone treatment without taper. The scleritis worsened 1 week later, so prednisone treatment (30 mg/d) was restarted; the dosage was later increased (60 mg/d) owing to continued deterioration. Despite 3 months of tuberculosis therapy and treatment with oral prednisone, new nodules developed (Figure 1A). Because the infectious disease service was convinced that the scleritis did not represent infection with tuberculosis, treatment with cyclophosphamide (150 mg/d) was started but was discontinued after 10 days because of worsened scleritis. Scleral biopsy was recommended to rule out multidrug-resistant Mycobacterium, but the patient refused and sought another opinion. She continued receiving prednisone (40 mg/d) with antituberculosis therapy elsewhere.