Visual recovery and vascular reperfusion after vaso-occlusive retinopathy from anti-phospholipid syndrome associated with systemic lupus erythematosus.
APLS
Case report
Systemic lupus erythematosus
Vaso-occlusive retinopathy
Journal
American journal of ophthalmology case reports
ISSN: 2451-9936
Titre abrégé: Am J Ophthalmol Case Rep
Pays: United States
ID NLM: 101679941
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
03
10
2019
revised:
08
01
2020
accepted:
31
05
2020
entrez:
20
6
2020
pubmed:
20
6
2020
medline:
20
6
2020
Statut:
epublish
Résumé
To report a case of visual recovery and vascular reperfusion after vaso-occlusive retinopathy from anti-phospholipid syndrome associated with systemic lupus erythematosus. A 15-year-old boy with a known diagnosis of systemic lupus erythematosus and a clinically significant anti-phospholipid panel presented with sudden vision loss in the left eye. Examination and ocular imaging revealed signs of vaso-occlusive retinopathy. The patient was immediately started on high dose intravenous steroids, followed by mycophenolate mofetil. He remained on aspirin. After showing no improvement in retinal arteriole and capillary perfusion he was started on therapeutic anti-coagulation with enoxaparin. He regained 20/20 vision. Intravenous fluorescein angiography demonstrated reperfusion of retinal arterioles. Optical coherence tomography angiography showed return of flow in the capillary networks. We present a case of vaso-occlusive retinopathy in a patient with known systemic lupus erythematosus and a clinically significant anti-phospholipid panel, thus meeting criteria for anti-phospholipid syndrome. He was treated with intravenous methylprednisolone, mycophenolate motefil, aspirin, and enoxaparin. The patient not only had great recovery of visual acuity, but also demonstrated reperfusion of arterioles and reconstitution of flow in the retinal capillary network. These findings suggest that the vaso-occlusive disease is reversible if the diagnosis is made promptly and intensive therapy is initiated. Currently there are no reported cases of vaso-occlusive retinopathy from APLS and SLE with visual recovery, reperfusion, and return of capillary flow.
Identifiants
pubmed: 32551401
doi: 10.1016/j.ajoc.2020.100763
pii: S2451-9936(20)30114-6
pii: 100763
pmc: PMC7287235
doi:
Types de publication
Case Reports
Langues
eng
Pagination
100763Informations de copyright
© 2020 The Authors.
Références
Br J Ophthalmol. 1972 Nov;56(11):800-4
pubmed: 4647128
J Thromb Haemost. 2006 Feb;4(2):295-306
pubmed: 16420554
Arch Ophthalmol. 1986 Apr;104(4):558-63
pubmed: 3954661
Lupus. 2011 Feb;20(2):206-18
pubmed: 21303837
Retin Cases Brief Rep. 2012 Spring;6(2):187-8
pubmed: 25390959
Ophthalmology. 2005 May;112(5):e19-23
pubmed: 15878050
Retin Cases Brief Rep. 2017 Winter;11 Suppl 1:S44-S48
pubmed: 27548039
Can J Ophthalmol. 2005 Feb;40(1):87-9
pubmed: 15825539
Can J Ophthalmol. 2017 Feb;52(1):e13-e15
pubmed: 28237161
JAMA Ophthalmol. 2016 Apr;134(4):466-7
pubmed: 26891887
Medicine (Baltimore). 2017 Jan;96(2):e5754
pubmed: 28079801
Ann Rheum Dis. 1982 Oct;41(5):473-8
pubmed: 7125716
Curr Opin Ophthalmol. 2008 Nov;19(6):512-8
pubmed: 18998618
Arthritis Rheum. 1988 Sep;31(9):1105-10
pubmed: 3422014
Br J Ophthalmol. 2016 Jan;100(1):135-41
pubmed: 25904124
Clin Exp Ophthalmol. 2004 Feb;32(1):87-100
pubmed: 14746601
Rheum Dis Clin North Am. 2015;41(1):109-23, ix
pubmed: 25399943
Lupus. 2006;15(1):3-12
pubmed: 16482739
Lupus. 2016 Oct;25(12):1365-8
pubmed: 26945023