|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 202-203
Unilateral retinopathy in a case of systemic lupus erythematosus
Pradeep Kumar Panigrahi, Lipika Mehra
Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
|Date of Submission||24-Oct-2021|
|Date of Acceptance||22-Nov-2021|
|Date of Web Publication||03-May-2022|
Dr. Pradeep Kumar Panigrahi
Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be University), 8-Kalinga Nagar, Bhubaneswar - 751 003, Odisha
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Panigrahi PK, Mehra L. Unilateral retinopathy in a case of systemic lupus erythematosus. Indian J Rheumatol 2022;17:202-3
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by formation of nuclear autoantigens and immune complexes which results in inflammation of multiple organs. Clinical presentation is highly variable and can involve multiple organs including skin, kidney, joints, and nervous system. The disease tends to have a chronic remitting and relapsing course. Therapeutic approaches mainly involve immunomodulation and immunosuppression and are targeted to the specific organ manifestation. SLE can involve multiple parts of the eye including eyelid, adnexa, sclera, cornea, optic nerve, uvea, and retina. Ocular symptoms are related to the systemic disease activity and can be the initial manifestation of the disease. Permanent blindness can result from optic nerve or retinal involvement. We report a rare case of unilateral retinopathy in a newly diagnosed case of SLE.
A 17-year-old female patient presented with sudden onset painless loss of vision in right eye (RE) of 2 days duration. She had been recently diagnosed with SLE. The patient presented to the rheumatology department with a history of erythematous macular rash over face, nonpainful oral ulcers over hard palate, buccal mucosa, lips, and intermittent fever of 1 month duration. Antinuclear antibody (4+), anti ds DNA, anti ss-A, and ss-B tests were positive. Hematological investigations revealed bicytopenia (leucopenia with neutropenia and thrombocytopenia). Splenomegaly was noted on ultrasound abdomen. Systemic lupus erythematosus disease activity index was 15. She was being treated with oral prednisolone (30 mg), hydroxychloroquine (300 mg), and azathioprine (25 mg). Best-corrected visual acuity in RE was 6/36, N12. Fundus examination of RE showed numerous cotton wool spots [Figure 1]a and macular edema [Figure 1]a. Optical coherence tomography of RE showed cystoid macular edema with increased central macular thickness [Figure 1]b. She was advised intravitreal bevacizumab in RE and increase in dose of oral steroids. There was a gradual improvement in vision and reduction in macular edema. One month after presentation, vision had improved to 6/9, N6 in the affected eye.
|Figure 1: (a) Colour fundus photograph of right eye showing cotton wool spots (white arrow) and macular edema (yellow arrow). (b) Optical coherence tomography scan of right eye showing cystoid macular edema (yellow arrow)|
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Retinopathy in SLE is associated with severe disease and poorer prognosis. Retinal involvement in SLE can take the form of cotton wool spots, retinal hemorrhages, retinal detachment, vasculitis, disc edema, and optic atrophy. Purtscher-like retinopathy is a type of retinal involvement which occurs due to the formation of microemboli and can result in retinal vascular occlusion and microvascular infarcts. The management of SLE retinopathy includes the institution of aggressive systemic steroids and immunosuppressants. They can be associated with widespread areas of capillary nonperfusion which can lead to retinal neovascularization in future. Ocular therapy includes intravitreal anti-vascular endothelial growth factors and posterior sub tenon injections of triamcinolone acetonide. Pan retinal photocoagulation will be required for retinal neovascularisation and pars plana vitrectomy for complications such as vitreous hemorrhage and tractional retinal detachment. In our case, the patient developed retinopathy features even though she was on systemic medications. This indicated that the disease was severe and the dosage of medications being used was insufficient to control the disease activity. Increasing the dosage of systemic medications and instituting local ocular therapy brought the retinopathy under control successfully. SLE retinopathy can lead to permanent blindness. SLE retinopathy can be an early manifestation of the disease. All patients diagnosed with SLE and especially those patients with severe disease should undergo ophthalmoscopy to rule out retinopathy. Prompt diagnosis and aggressive treatment can help in preventing vision loss.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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