Case Report: Monocular Purtscher-like retinopathy secondary to systemic lupus erythematosus: analysis of clinical characteristics under low disease activity

Objective This study aims to report a case of unilateral Purtscher-like retinopathy (PLR) secondary to systemic lupus erythematosus (SLE) and explore its clinical features, diagnosis, and therapeutic outcomes. Methods A retrospective analysis was performed on the clinical data of a 23-year-old female SLE patient, including medical history, ophthalmic examinations, visual acuity, fundus assessment, optical coherence tomography (OCT), fundus fluorescein angiography (FFA), laboratory tests, and treatment follow-up results. The patient was admitted with acute left eye vision loss for over 2 days and had an 8-year history of SLE. Clinical manifestations included left eye Purtscher flecken and retinal microcirculatory abnormalities. Results The initial left eye visual acuity was 0.05 (no improvement with correction). The fundus examination revealed Purtscher flecken along vascular tracts, OCT showed hyperreflectivity in the inner macular retina, and FFA confirmed PLR. The laboratory tests indicated elevated erythrocyte sedimentation rate (109.00 mm/h), increased immunoglobulin G (34.88 g/L), and a SLE Disease Activity Index score of 4 (low disease activity). The treatment included prednisone acetate combined with cyclophosphamide for primary disease control, Guhong Injection for circulatory improvement, peribulbar injection of compound anisodine combined with methylcobalamin for neuroprotection, and laser photocoagulation for macular non-perfusion areas. After 11 days of treatment, the left eye visual acuity improved to 0.25 with symptom relief; the 1-month follow-up showed reduced Purtscher flecken, improved macular hyperreflectivity, and stable vision. Conclusion PLR is a rare ocular complication of SLE that can occur even during low disease activity. Early diagnosis combined with primary disease control, microcirculatory improvement, and laser therapy can effectively improve visual prognosis, highlighting the importance of regular fundus screening for SLE patients.