A CASE OF ACUTE VISUAL LOSS AS THE PREDOMINANT CLINICAL MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS

Background: Ophthalmologic symptoms represent a rather rare but dangerous manifestation of systemic lupus erythematosus (SLE).Results: A 34-year-old woman presented with periorbital edema and progressive visual loss. Periorbital edema was first observed 2 weeks before admission, particularly in the mornings. Visual loss started 5 days prior to admission. Visual acuity was 0.1 bilaterally. Ophthalmologic examination revealed pronounced edema of the retina and serous retinal detachment involving the fovea. Early and late phase fluorescein angiograms shows numerous leak sites, multiple punctate hyperfluorescence corresponding to the area of retinal alteration as well as filling of retinal detachment spaces. Because of the acute visual loss accompanied with periorbital edema and moderate protein excretion (1.2 g per 24 h) the patient underwent a renal biopsy. Conventional histology showed no pathological glomerular alterations. However, FITC immunofluorescence staining for IgG revealed granular IgG deposits predominantly in the mesangium. These findings are consistent with lupus glomerulonephritis class I according to the 2002 WHO/ISN/RPS classification. Based on these findings, the diagnosis of SLE was made. The patient was treated with 250 mg prednisolone for 3 days. The eyes were treated locally with prednisolone as well. The visual acuity improved markedly by 3 weeks. Six months after treatment prednisolone was reduced to a maintenance level. Her visual acuity was 0.8 bilaterally and the protein excretion decreased to 0.3 g per 24 h. No other immunosuppressive drugs were given.Conclusion: In case of acute visual loss the consequent search for other manifestations of SLE may help to save patients visual power.Citation: , volume , supplement , year 2004, page Session: SLE – Clinical aspects