Case Report Bilateral Retinal Vasculitis: A Vision-threatening Flare of Systemic Lupus Erythematosus

ABSTRACT: Retinal vasculitis is a rare but severe manifestation of systemic lupus erythematosus (SLE) that can lead to profound visual morbidity if not promptly recognized and aggressively managed. We report a case of a 21-year-old female with a history of SLE diagnosed in 2023 with mucocutaneous and hematological involvement, who presented with bilateral vision-threatening retinal vasculitis following a 2-year period of noncompliance with immunosuppressive therapy. The patient initially experienced low-grade fever for 5 months, followed by a generalized tonic-clonic seizure and progressive bilateral painless visual deterioration over 15 days, accompanied by dyspnea on exertion and oral ulcers. Ophthalmic examination revealed bilateral retinal vasculitis with macular edema, retinal hemorrhages, vascular sheathing, and extensive capillary nonperfusion on optical coherence tomography angiography. Visual acuity at presentation was 6/36 in the right eye and finger counting at close to face in the left eye. Systemic investigations confirmed active SLE with anemia, elevated inflammatory markers, and positive antinuclear antibodies. The patient was managed with high-dose intravenous methylprednisolone for 3 days followed by oral prednisolone, mycophenolate mofetil, and hydroxychloroquine, along with sectoral laser photocoagulation for ischemic areas. After treatment, significant improvement was observed with resolution of hemorrhages, decreased macular edema, improved visual acuity to 6/12 bilaterally, and reduction in capillary dropout areas. This case emphasizes the critical importance of multidisciplinary management and strict adherence to immunosuppressive therapy in SLE patients to prevent sight-threatening complications.