<Case Reports> A rare case of a severe ocular complication as an initial presentation of adolescent-onset systemic lupus erythematosus: a case report

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[Abstract] Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that causes severe complications in multiple organs. Ocular manifestations are critical in patients with SLE because of the vision-threatening risk of such complications. However, severe retinopathy as an initial presentation of SLE is uncommon, even when the severity of SLE is mild, especially in children. Case presentation: We encountered a 14-year-old female patient with rapidly progressive impairment of her left vision that was determined to be caused by severe retinopathy secondary to SLE. Her other systemic symptoms, including a mild renal disorder, were not severe. The patient showed positivity for anticardiolipin antibody, although she did not have antiphospholipid antibody syndrome. She was initially treated with high-dose methylprednisolone, antiplatelet therapy,and anticoagulation therapy because of the high possibility of vision loss; this was followed by tacrolimus as maintenance therapy. Photocoagulation therapy was also performed to prevent vitreous hemorrhage and retinal detachment. Early diagnosis of SLE based on the rapid deterioration of her vision allowed for early interventions and a good clinical course with recovery of her vision. Conclusions: Importantly, regardless of the severity of the systemic symptoms in patients with SLE, ocular involvement is critical and requires aggressive treatment.

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