SLE: Purtscher-like retinopathy

Abstract

Purtscher-like retinopathy is a rare vaso-occlusive retinopathy associated with systemic lupus erythematosus (SLE). We present a case of unilateral Purtscher-like retinopathy in an SLE patient. A 27-year-old female with SLE presented with sudden, painless visual decline in her right eye (RE) over two months. She was experiencing an SLE flare with an SLE Disease Activity Index of 15. She was started on oral prednisolone, azathioprine, and hydroxychloroquine by rheumatologist. On examination, her right visual acuity (VA) was 6/38 while left VA was 6/7.5, with a positive relative afferent pupillary defect in the right eye. Optical coherence tomography of the right eye showed hyperreflectivity in the retinal nerve fibre layer and retinal thickening. Fundus examination of the right eye revealed multiple Purtcher’s flecken surrounding the optic disc and posterior pole along with intraretinal haemorrhages. Left eye was unremarkable. Fundus fluorescein angiogragraphy(FFA) of the right eye revealed hot disc, occlusive vasculitis with extensive capillary fallout. She was treated with intravenous methylprednisolone at 1g/day for 3 days, followed by a tapering dose of oral prednisolone. Full pan retinal photocoagulation was performed. After three months of treatment, her right eye VA improved to 6/24. Her retinal remained quiescent and she was asymptomatic for past one year. In conclusion, SLE Purtscher-like retinopathy can involve unilateral or bilateral eyes and has a severe prognosis. Effective treatment involves systemic steroids and immunosuppresants. Prompt recognition is essential for guiding treatment and preserving visual function.