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Retinal microangiopathy as primary manifestation of systemic lupus erythematosus
Author(s) -
Almenara C.,
Núñez E.,
Ascaso F.,
Pérez I.,
Martínez M.,
Esteban O.,
Sánchez J.I.,
Idoate A.,
Bartolomé I.,
Berniolles J.,
Cristóbal J.Á.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0258
Subject(s) - medicine , microangiopathy , cotton wool spots , fundus (uterus) , ophthalmology , hydroxychloroquine , thrombotic microangiopathy , fluorescein angiography , uveitis , intraocular pressure , dermatology , visual acuity , retinal , retinopathy , pathology , diabetes mellitus , disease , covid-19 , infectious disease (medical specialty) , endocrinology
Purpose Systemic lupus erythematosus (SLE) is a complex connective tissue disorder that involves multiple organs, including several opththalmic structures. The prevalence of retinopathy ranges from 3 to 29% and the autoimmune process affects the retina in two ways, directly by deposition of immune complexes and indirectly by arterial hypertension secondary to renal involvement. Although uncommon, ocular manifestations can precede systemic features, and their early diagnosis is the key to successful and better prognosis. Methods We present a case of retinal microangiopathy as primary manifestation of systemic lupus erythematosus (SLE). The patient is a 37‐years old woman, who presented at the Emergency department with a 24‐h history of floaters in her right eye (RE). Systemic review revealed arthralgias for the past 6 months. Best‐corrected visual acuity (BCVA) was 20/20 in both eyes. Pupillary reflexes, slit‐lamp biomicroscopy examination and Goldmann applanation intraocular pressure (IOP) were normal. Fundus examination showed bilateral dot haemorrhages and cotton wool spots. Spectral‐domain optical coherence tomography (SD‐OCT) and fluorescein angiography were also normal. Results Blood investigations revealed anemia, leucopenia and thrombocytopenia, without any affectation of renal function. Based on the clinical findings and serology results, a diagnosis of SLE was made. The patient was treated with intravenous methylprednisolone followed by oral prednisolone which was then gradually tapered. Retinal signs resolved two months following treatment. Conclusions This case illustrates that retinopathy can be a primary presenting manifestation in a SLE patient who is apparently healthy.