Abstract
Background and Aims Eye involvement in SLE is seen in around one third of patients. Retinal involvement is an uncommon but potentially vision threatening complication.
Methods To report the case of a young boy with isolated retinal involvement as the only manifestation of lupus.
Results A 9 year old previously healthy boy presented with complaints of fever, vomiting, seizures and alteration of sensorium. He had signs of raised intracranial pressure and rest of the examination was unremarkable (Investigations in Table 1 and 2). He was managed as a case of viral meningo-encepahlitis though his CSF examination and neuroimaging revealed no abnormality. He was incidentally detected to have cotton wool spots in both eyes. After recovering from acute illness, he was also noted to have low vision in both eyes (light perception at 3 feet) Subsequently,a fundus fluorescein angiography was done that revealed capillary ‘drop-out’, vessel wall staining and leakage of dye. (Figure 1) He had antinuclear antibodies (4+ speckled pattern). A diagnosis of SLE with isolated retinal involvement (vasculopathy) was considered. In view of severely impaired visual acuity, he was managed with injection cyclophosphamide (followed by maintenance mycophenolate mofetil) and pulse methylprednisolone (followed by oral prednsiolone). One year on follow up, his visual acuity has improved to 6/60 in both eyes. Repeat FFA revealed significant decrease in the non perfused areas of retina.
Laboratory investigations
Conclusions Eye involvement in paediatric lupus is underecognized entity and may need aggressive therapy.
