Título

MULTIPLE BILATERAL RETINAL PIGMENT EPITHELIAL DETACHMENTS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS DISEASE

Objetivo

To report a clinical case of multiple bilateral retinal pigment epithelial detachments (PED) in a woman with systemic lupus erythematosus (SLE).

Relato do Caso

Female subject, 27 years (YR) old, came for an evaluation, asked by rheumatology team. She was admitted 7 days earlier due to worsening of renal function and uncontrolled high blood pressure (HBP). She had previous diagnosis of SLE, G6PD deficiency and immune thrombocytopenic purpura with irregular follow-up. HBP was over 150x90 mmHg for more than 1,5 YR and she used corticosteroids for more than 5 YR, varying dose. On hospitalization, she was with prednisone (PRED) 60mg daily (QD) as they identified class IV lupus nephritis. She complained of mild blurred bilateral vision on both eyes (OU) since a few months, without pain or any other symptoms and no previous assessments. Best corrected visual acuity (BCVA) was 0,7/0,6, right/left eye respectively. On our evaluation she presented with a normal biomicroscopy exam, on fundoscopy she had lacy retinal pattern, remarkably on macula OU. No elevated intraocular pressure. Complementary investigation revealed: multiple bilateral serous PED and paquychoroid OU on Optical Coherence Tomography. Fluorescein angiography displayed progressive hyperfluorescent areas with intense pooling OU. She returned 2 months later, using PRED 30mg QD, in regression, mycophenolate mofetil and 3 antihypertensive drugs (regular use). BCVA was 0,9/0,8. Despite BCVA improvement, examination showed no changes yet.

Conclusão

Ocular involvement, with variable findings, affects nearly 1/3 of SLE patients. Choroidal and retinal conditions are associated with visual loss and poor systemic control. Multiple bilateral PED has already been described and in this case could be related to: SLE choroidopathy; central serous chorioretinopathy-like disease due to chronic corticosteroids use and/or hypertensive choroidopathy. Such conditions management, reduction of corticosteroids along with immunosuppressant and antihypertensives, are being performed to attain systemic and ocular recovery.