Systemic lupus erythematosus complicated with optic neuritis: a case

1 clinical dataThe female patient, 21 years old, right eye suddenly decreased visual acuity with eyeball pain for 2 months. The worst vision

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1 clinical data

The female patient, 21 years old, right eye suddenly decreased visual acuity with eyeball pain for 2 months. The worst vision to light treatment in a hospital in Beijing City, diagnosed as retrobulbar neuritis, glucocorticoid and neurotrophic drug treatment, visual acuity before manual. After our hospital admission examination: visual acuity 0.12 (-7.00DS), RAPD+, clear pale optic disc. Fundus fluorescein angiography showed no abnormalities. VEP showed that the P100 wave latency of the right eye was significantly delayed in the low, middle and high spatial frequencies, and the P100 wave amplitude decreased slightly under the condition of low spatial frequency. Right temporal visual field defect. Head CT plain scan showed no obvious abnormality. Right eye OCT: macular scan is normal. Immunological examination: the positive antinuclear antibody titers of 1:640 (homogeneous particles), anti double stranded DNA antibody titer stoste positive anti SSA antibody. Patients with previous history of SLE 5 years, oral prednisone control the disease, not the law review and treatment. Chairman of the Department of rheumatism after consultation given prednisone, azathioprine immunosuppression, nutrition nerve, improve circulation, oral therapy, visual acuity recovered to 0.25 (-7.00DS) and discharged after discharge to oral prednisone and azathioprine therapy.

2011 02, 2009, patients with hands and face erythema for 44 days, left eye vision and visual field defects decreased again on the 9 day of admission to the hospital on. Check the body: hands back and face skin erythema, round, diameter of about 5mm. Visual acuity: right eye 0.1 (-7.00DS), light localization of temporal difference; left eye 0.5 (-4.50DS), accurate positioning. Right RAPD (+), right eye disc pale, clear boundary, left eye optic nasal boundary was not clear, pale red color. Combined with the consultation of the Department of rheumatism and the internal medicine department of the kidney, the treatment of hormone shock, nutrition nerve and promoting microcirculation. Visual acuity returned to the right eye 0.5 (-7.0DS) and left eye was 0.8 (-4.50DS).

2 discussion

Systemic lupus erythematosus is a chronic, multisystem autoimmune disease, approximately 1/3 of patients have ocular manifestations, 0.7%1% patients with optic neuropathy, including optic neuritis and ischemic optic neuropathy. SLE patients with optic neuropathy, male and female ratio of about 1:5, the average age of onset was 33 + - 13 years, with an average incidence of a period of 3 years. Including the pathological mechanism most likely: the cytotoxicity of antibody dependent cell death leads to retinal and optic nerve demyelination (optic neuritis); optic nerve block small blood vessels caused by optic nerve ischemia (ischemic optic neuropathy).

Systemic lupus erythematosus associated with optic neuritis is rare, but the eye doctor can put it with idiopathic optic neuritis of the identification is very important, because it will have a very serious visual impairment and hormone dependent. Early diagnosis and prompt treatment are very important for the recovery of visual function. Optic neuritis showed acute unilateral eye visual loss with eyeball pain. The optic neuropathy in patients with SLE is usually a painless visual loss involving both eyes, with a high degree of curvature of the visual field. Optic neuritis of young women, after exclusion of other causes, should consider the possibility of SLE.

The treatment of the disease can choose corticosteroids and cyclophosphamide, some patients still need anticoagulation and / or immunosuppressive agents. The prognosis of visual acuity in patients with SLE is often poor, although there are some cases with better visual acuity. Recurrence can worsen the prognosis of vision. The degree of visual recovery varies, early

 

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