Unilateral Retinal Vasculitis as an Initial Presentation of Systemic Lupus Erythematosus: A Case Report

Purpose: To report a case of unilateral retinal vasculitis as the initial presentation of systemic lupus erythematosus (SLE).Case summary: A healthy 26-year-old Cambodian woman presented with sudden vision loss in the right eye.Best-corrected vision in the right eye was 0.1, and multiple cotton-wool spots, intraretinal hemorrhages, and macular edema of the posterior pole were observed while the anterior chamber and vitreous were clear.Widefield fluorescein angiography revealed extensive occlusive vasculitis in the right eye.The patient reported a habit of consuming raw meat, fish, and crustaceans, and complained of desquamation of the hands, legs, and scalp, with alopecia.Blood tests were positive for varicella-zoster virus and cytomegalovirus IgM and IgG, herpes simplex virus IgG, antinuclear antibody, lupus anticoagulant, anti-cardiolipin antibody, anti-dsDNA antibody, and C3 levels were decreased.Aqueous humor PCR testing for viral infection was negative.To prevent worsening of concurrent viral infection, oral valganciclovir was started.At oneweek follow-up, the macular edema and cotton wool spots had worsened.Oral corticosteroid was prescribed in addition to antiviral treatment.At one-month follow-up, the macular edema and cotton-wool spots in the right eye had completely disappeared, and corrected vision improved to 0.5.The patient was finally diagnosed with SLE after consultation with a rheumatologist.Conclusions: Prompt systemic evaluation is warranted in cases of suspected lupus retinopathy to ensure appropriate diagnosis and treatment of SLE.