Primary antiphospholipid syndrome masquerading as diabetic retinopathy

Primary antiphospholipid syndrome (PAPS) is a thrombotic condition which characteristically includes ocular vaso-occlusive pathology.

We present the case of a 47-year-old woman with PAPS presenting with retinal vascular leakage.

Vascular leakage was an incidental finding on fundoscopy in a myopic Chinese woman, and initially this was diagnosed as diabetic retinopathy. However, a glucose tolerance test was negative. Subsequently, signs of retinal vaso-occlusion developed. Previous subclinical cerebral thrombosis, mild thrombocytopaenia and positive tests for antiphospholipid antibodies were consistent with the diagnosis of PAPS. Anticoagulation therapy with warfarin prevented further thrombotic episodes.

The possibility of PAPS should be considered in patients presenting with retinal vascular disease without obvious vascular risk factors.