Post–Caesarean Section Bilateral Cortical Blindness in a Primigravida With Systemic Lupus Erythematosus: A Case Report

Systemic lupus erythematosus (SLE) increases the risk of morbidities during pregnancy, including stroke, thrombophilia, and antepartum bleeding. There are few case reports in English literature where bilateral cortical blindness has been described for a pregnant subject with prior SLE. In this report, a 32-year-old primigravida, a known case of SLE, was admitted with premature rupture of membranes at 34 weeks of gestation. Three hours after admission, due to vaginal bleeding, a healthy baby was delivered through emergency cesarean section under general anesthesia because of recent use of anticoagulants. In the recovery room, an elevated systolic blood pressure of 180 mmHg was noticed and controlled. After recovery, the patient complained of severe blurred vision. There were no abnormal findings on ophthalmologic examination but her brain MRI revealed bilateral occipital lesions. Bilateral cortical blindness is a rare incident during the pregnancy of an SLE patient without preeclampsia or eclampsia. Differential diagnoses, considering all the evidences, were posterior reversible encephalopathy syndrome (PRES) and ischemic stroke. Finally, we discuss the challenges of making a definitive final diagnosis, the importance of close follow-up for such cases, and control of underlying disease before pregnancy in such cases.