A 72-year-old man was referred for unilateral scleritis refractory to topical corticosteroid therapy. His history was remarkable for having been diagnosed with unilateral uveitis in the left eye in 2005 at another hospital, the details of which were unknown. On examination, the corrected visual acuities were 0.5 OU, with normal intraocular pressure. The right eye was entirely normal, but the left eye exhibited marked scleral hyperemia in all 4 quadrants (Figure 2A). In addition, although the vitreous was clear, retinal and choroidal folds in the superior macular area were noted. Laboratory investigation results were positive for the presence of perinuclear antineutrophil cytoplasmic antibodies and an elevated erythrocyte sedimentation rate of 41 mm/h. The TST results showed 40 mm of erythema and 10 mm of induration; however, chest radiography examination was normal. Results of subsequent QFT testing were positive. An orbital computed tomographic scan confirmed diffuse thickening of the posterior eye wall and unilateral anterior and posterior scleritis was diagnosed, possibly due to TB. The patient was treated with a 4-drug regimen (isoniazid, 300 mg/d; rifampicin, 450 mg/d; ethambutol hydrochloride, 750 mg/d; and pyrazinamide, 1500 mg/d) for the first 2 months, followed by the same doses of isoniazid and rifampicin for 7 months. The scleritis improved within 2 months of initiating anti-TB therapy, and no recurrences were observed over 3 months of follow-up since completing treatment (Figure 2B).