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Related Experiment Videos

Lupus optic neuritis with negative serology.

T A Deutsch1, H L Corwin

  • 1Department of Ophthalmology, Rush-Presbyterian-St. Lukes Medical Center, Chicago, IL 60612.

Annals of Ophthalmology
|October 1, 1988
PubMed
Summary
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Systemic lupus erythematosus (SLE) can cause optic neuritis, but diagnosis is challenging with negative serology. This case highlights the difficulty in diagnosing SLE-related optic neuritis when autoantibody and complement levels are normal.

Area of Science:

  • Ophthalmology
  • Rheumatology
  • Infectious Disease

Background:

  • Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
  • Ocular manifestations, including optic neuritis, can occur in SLE patients.
  • Diagnosis of SLE typically relies on clinical findings and serological markers like antinuclear antibodies (ANA) and complement levels.

Observation:

  • A 56-year-old woman with a 12-year history of SLE presented with severe optic disc swelling and blepharitis.
  • Concurrently, she developed acute pancreatitis and subsequently died from gram-negative sepsis.
  • Despite severe symptoms suggestive of lupus activity, her serum ANA and complement levels were normal throughout hospitalization.

Findings:

  • The patient's severe ocular and systemic symptoms appeared to be lupus manifestations.

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  • However, the absence of typical serological markers complicated the diagnosis.
  • Optic neuritis, a potential complication of SLE, proved difficult to confirm due to negative lupus serology.

    • Implications:

    • This case underscores the diagnostic challenges in SLE when serological markers are unsupportive.
    • It suggests that optic neuritis can be a manifestation of SLE even with normal ANA and complement levels.
    • Clinicians should consider SLE in the differential diagnosis of optic neuritis, even in the absence of positive serology, and explore alternative diagnostic approaches.