Purtscher-like retinopathy as a first presentation of systematic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease, characterized by the involvement of multiple organ systems. Ocular involvement, being one of the manifestations, contributes to the assessment of disease activity. Purtscher-like retinopathy has been reported as a manifestation of SLE. An otherwise healthy 21-year old female presented with a bilateral rapid decrease in vision for 1 month. Fundus examination revealed multiple cotton wool spots and flame-shaped hemorrhages in both eyes. Optical coherence tomography displayed bilateral severe macular edema. Fundus fluorescein angiography showed multiple retinal arteriolar occlusions. A rheumatologist was consulted for investigation. Based on the American College of Rheumatology 1982 Revised Criteria for diagnosing SLE, a diagnosis of SLE was made. She was subsequently treated with corticosteroids and immunosuppressive medication. Although vaso-occlusive retinopathy is a rare presentation of SLE, it is significant in diagnosing SLE in a patient, to promptly initiate proper treatment.