Systemic Lupus Erythematosus with Purtscher-Like Retinopathy as the First Symptom

Abstract

Purpose: To report a case of purtscher-like retinopathy as the primary manifestation in patient with systemic lupus erythematosus (SLE).Case summary: A 44-year-old healthy female presented with decreased visual acuity in both eyes. On fundus examination, multiple cotton wool spots and retinal hemorrhages on the posterior pole were observed. On fluorescein angiography, nonperfusion and vascular leakage were observed at the posterior pole of both eyes. On optical coherence tomography, there were increased hyperreflectivity in the retinal nerve fiber layer and ganglion cell layer, intraretinal fluid, and subretinal fluid. On serological tests including thrombophilia examination, anti-Ro antibodies, anti-dsDNA antibodies, anti-Sm antibodies were positive. She was diagnosed with SLE. After 1 month of systemic steroid and hydroxychloroquine treatment, the intraretinal fluid and subretinal fluid resolved, but visual acuity was not recovered.Conclusions: In patients without underlying disease, it should be considered that multiple cotton wool spots and retinal hemorrhages may be Purtshcer-like retinopathy and may appear as a primary manifestation of an autoimmune disease such as SLE.