Purtscher-Like Retinopathy In A Children With Systemic Lupus Erythematous (SLE)

Abstract

Purtscher-like retinopathy is a rare ocular manifestation in systemic lupus erythematosus (SLE). Objective: To report a case of Purtscher-like retinopathy in a 10-year-old female child with SLE. Case presentation: A 10-year-old Chinese girl was presented with lethargy for four weeks and intermittent fever for two weeks. The fever was associated with multiple body rashes. She was treated as pyrexia of unknown origin. Generally she was febrile with temperature of 39°C, presence of facial rash and discoid rashes involving both hands with generalised erythematous skin over the hernial region. Patient was referred by the paediatrics team to rule out any ocular association of connective tissue disease. Fundus examination showed presence of generalised Purtscher-like retinopathy. Blood investigation revealed leukopenia, anaemia, low complement (C) 3 (C3) and C4 with positive both antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) antibody. She was finally diagnosed as childhood-onset systemic lupus erythematous (SLE) and was treated systemically with prednisolone, mycophenolate mofetil (MMF) and hydrochloroquine by paediatric team. There was improvement of visual acuity with resolution of Purtscher-like retinopathy at one year review. Conclusion: Childhood-onset SLEpresented without visual complaints must be evaluated thoroughly for Purtscher-like retinopathy. Early recognition and treatment lead to a better visual outcome.