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Case report
When systemic lupus erythematosus affects vision: a rare presentation of this condition
  1. Tiago Gama Ramires1,2,
  2. Luísa Vieira3,
  3. Nuno Riso4 and
  4. Maria Francisca Moraes-Fontes2
  1. 1Medicina 2, Hospital do Espirito Santo E.P.E, Évora, Portugal
  2. 2Unidade de Doenças Auto-imunes/Medicina 7.2, HospitalCurry Cabral, Centro Hospitalar de Lisboa Central E.P.E, Lisboa, Portugal
  3. 3Serviço de Oftalmologia, Hospital de Santo Antonio dos Capuchos, Centro Hospitalar de Lisboa Central E.P.E, Lisboa, Lisboa, Portugal
  4. 4HospitalCurry Cabral, Centro Hospitalar de Lisboa Central E.P.E, Lisbon, Portugal
  1. Correspondence to Dr Tiago Gama Ramires; tiago.raposo.ramires{at}gmail.com

Abstract

A 23-year-old woman with fever, oral ulcers, arthalgias and weight loss of 2-week duration suddenly developed blurred vision, with reduced visual acuity, cotton wool exudates and retinal vascular tortuosity. Laboratory testing revealed anaemia, lymphopaenia, positive antinuclear antibody and high anti-dsDNA antibody titre with low complement components. There was no evidence of infection, clinching the diagnosis of lupus retinopathy. Steroid therapy alone was highly effective and was also accompanied by a normalisation of haemoglobin and lymphocyte counts, after which azathioprine was added. Hydroxychloroquine was introduced after resolution of retinal changes. Immunosuppressive therapy was progressively tapered over the course of 12 months and then discontinued, and the patient remains in remission 48 months after the initial presentation. Our patient exemplifies a very rare manifestation of systemic lupus erythematosus. We emphasise the importance of its early detection and complexity of treatment in order to reduce visual morbidity.

  • systemic lupus erythematosus
  • retina
  • immunology
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Footnotes

  • Contributors TGR: collected and analysed data and writting. LV: collected and analysed images and text review. NR: text review. MFM-F: collected and analysed data and text review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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