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Título

RELAPSING VISUAL LOSS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND CYSTIC CHIASMOPATHY

Fundamentação/Introdução

Ophthalmologic and central nervous system (CNS) manifestations occur in 20 to 40% of patients with systemic lupus erythematosus(SLE). Involvement of the optic nerve or chiasm occurs in only 1% of patients with (SLE).

Objetivos

Here in we report to our knowledge, the first case in literature of a cystic recurrent chiasmitis associated with (SLE).

Delineamento e Métodos

A 49-year-old female presented with amaurosis in left eye and significant visual loss in right eye. History included multiple arthralgia, recurrent oral ulcers and skin photosensitivity. Examination disclosed BCVA of 20/20 in OD and counting fingers in OS; bilateral optic disc pallor (fig.1b), and OS showed a moderate relative afferent pupillary defect.
Optical coherence tomography showed a severe and diffuse thinning of the peripapillary retinal nerve fiber layer, which was more severe in the left eye (fig. 1c). Positive laboratory work-up included antinuclear antibody with cytoplasmic and nuclear dense fine speckled patterns, anti-dsDNA and IgG anticardiolipin antibodies. Cell-based assays for serum anti-aquaporin 4 antibody and anti-myelin oligodendrocyte glycoprotein yielded negative results. Search for infectious sexually transmitted diseases was also negative. MRI revealed a T2-hyperintense cystic lesion in the left part of the optic chiasm (fig. 2a), and hypersignal in T2/FLAIR in the periventricular regions and in the white matter of the left frontal lobe (fig. 2b). Visual field perimetry disclosed a superior temporal quadrantanopia in OD and preservation of just a nasal superior area in OS (fig. 2c) which suggested a chiasmal lesion. As the patient met the diagnostic criteria for SLE initial treatment was started.
Months after disease onset revealed BCVA of 20/20 in OD and counting fingers in OS. Goldmann visual field perimetry and brain MRI showed no change as compared with previous examinations.

Resultados

There are also other reports of patients with recurrent chiasmitis in SLE, but different from our case. Almeida GB et al. presented no optic disc edema, no signs of cystic lesion and a bitemporal visual field loss. SLE neuropathy is commonly bilateral and presents as an acute loss of vision, an altitudinal visual field defect and optic disc with or without edema. We could not find any other report of a recurrent chiasmitis associated with a cystic lesion related to SLE. 

Conclusões/Considerações Finais

This case highlights the noteworthiness of considering SLE as a rare differential diagnosis in visual loss secondary to cystic relapsing optic chiasmopathy.

Palavras-chave

Chiasmitis; SLE; Lupus; Cystic