SLE presenting as combined CRAO and CRVO in a patient: a cas
A 14-year-old girl reported with a chief complaint of sudden loss of vision in her left eye (LE) for one day. Visual acuity in the right eye (RE) was 20/20 and hand motion in LE. LE had relative afferent pupillary defect. LE fundus revealed combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO).

Anterior and posterior segment findings were unremarkable in RE. Despite aggressive treatment, there was no improvement in the visual acuity of LE. Next day, she developed characteristic erythematous butterfly rash and multiple raised patchy rashes over the head, trunk and arms. Laboratory investigations revealed increased erythrocyte sedimentation rate, elevated levels of C-reactive protein, antinuclear antibody, double-stranded DNA and slightly decreased complement-3 and complement-4.

Lupus anticoagulant and anticardiolipin antibodies were negative. She developed pancytopenia and lupus nephritis. Diagnosis of systemic lupus erythematosus (SLE) was made. Despite vigorous treatment, patient did not respond and died of terminal cardio-respiratory arrest due to bilateral aspiration pneumonitis with type 1 respiratory failure.

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Dr. J●●●●a R●●●●●●●●n
Dr. J●●●●a R●●●●●●●●n Paediatrics
Surprising to note patient didn' t have any symptoms of SLE before the ocular manifestations, though SLE can rarely follow a stormy course.
Dec 1, 2018Like2