SLE presenting as DAH and relapsing as refractory retinitis.

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems.
• Ocular manifestations are common in SLE, ranging from dry eye to sight-threatening conditions.
• Immunosuppressive therapy, including cyclophosphamide, steroids, and mycophenolate mofetil (MMF), is a cornerstone of SLE management.

Observation:

• A 17-year-old male with a history of SLE and diffuse alveolar hemorrhage (DAH) presented with gradual, painless vision loss in both eyes.
• He was on maintenance therapy with oral prednisolone and MMF.
• The patient denied recent SLE flares, including skin rash, joint pain, oral ulcers, photosensitivity, neurological deficits, or worsening renal function.

Findings:

• The patient's presentation suggests an ocular complication of SLE or its treatment.
• Painless vision loss in SLE can indicate conditions like lupus retinopathy, optic neuropathy, or uveitis.
• Despite immunosuppression, SLE activity can manifest in specific organs.

Implications:

• This case underscores the importance of regular ophthalmological surveillance in SLE patients, even those on maintenance therapy.
• Early detection and management of ocular complications are crucial to prevent irreversible vision loss.
• Further investigation is needed to determine the exact cause of vision loss and optimize treatment strategies.