Ptosis: an uncommon manifestation to autoimmune disease activity in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse manifestations, including rare neuro-ophthalmic complications. Isolated unilateral ptosis as a presenting sign of SLE is uncommon and diagnostic uncertainty often exists.

A 30-year-old woman with a 16-year history of SLE presented with acute right-sided ptosis without other neurological deficits while on stable maintenance immunosuppressive therapy. MRI of the brain and orbits, along with other relevant investigations, excluded common structural causes and showed no abnormalities. Serological testing indicated moderately active SLE, supporting an autoimmune flare as the likely mechanism. Myasthenia gravis-specific testing was not performed, a recognized limitation, but was considered clinically unnecessary given the absence of fatigability, diurnal variation, or generalized weakness. The ptosis resolved completely within 24 h of initiating high-dose systemic corticosteroid therapy.

Isolated unilateral ptosis may represent a rare neuro-ophthalmic manifestation of SLE, though alternative diagnoses cannot be definitively excluded. The rapid steroid response may suggest an inflammatory or autoimmune mechanism, underscoring the importance of considering such etiologies and initiating timely immunosuppressive therapy when appropriate.