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   Table of Contents      
OPHTHALMIC IMAGE
Year : 2018  |  Volume : 66  |  Issue : 12  |  Page : 1864

Combined central retinal artery and vein occlusion as the presenting manifestation of systemic lupus erythematosus


1 Department of Vitreo-Retina Surgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India
2 Department of Ophthalmology, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India

Date of Web Publication19-Nov-2018

Correspondence Address:
Dr. Pritam Bawankar
Department of Vitreo-Retina Surgery Services, Grant Medical College and Sir J.J. Group of Hospital, Byculla, Mumbai - 400 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_996_18

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How to cite this article:
Bawankar P, Samant P, Lahane S, Jain A, Pathak P. Combined central retinal artery and vein occlusion as the presenting manifestation of systemic lupus erythematosus. Indian J Ophthalmol 2018;66:1864

How to cite this URL:
Bawankar P, Samant P, Lahane S, Jain A, Pathak P. Combined central retinal artery and vein occlusion as the presenting manifestation of systemic lupus erythematosus. Indian J Ophthalmol [serial online] 2018 [cited 2019 May 21];66:1864. Available from: http://www.ijo.in/text.asp?2018/66/12/1864/245649



A 14-year-old girl visited to our outpatient department complaining of sudden loss of vision in her left eye (LE) for one day. Visual acuity in the right eye (RE) was 20/20 and hand motion in LE. LE had relative afferent pupillary defect. LE fundus revealed combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) [Figure 1]. Anterior and posterior segment findings were unremarkable in RE. Despite aggressive treatment, there was no improvement in the visual acuity of LE. Next day, she developed characteristic erythematous butterfly rash and multiple raised patchy rashes over the head, trunk and arms. Laboratory investigations revealed increased erythrocyte sedimentation rate, elevated levels of C-reactive protein, antinuclear antibody, double-stranded DNA and slightly decreased complement-3 and complement-4. Lupus anticoagulant and anticardiolipin antibodies were negative. She developed pancytopenia and lupus nephritis. Diagnosis of systemic lupus erythematosus (SLE) was made. Despite vigorous treatment, patient did not respond and died of terminal cardio-respiratory arrest due to bilateral aspiration pneumonitis with type 1 respiratory failure.
Figure 1: Left eye fundus image showing disc oedema, pale and oedematous retina, engorged and tortuous retinal veins, scattered intraretinal heamorrhages in all quadrants and a cherry-red macular spot, suggesting combined central retinal artery and vein occlusion

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Combined CRAO and CRVO as the presenting manifestation of SLE without raised antiphospholipid antibody levels has been rarely reported.[1],[2] This case reminds us that SLE must be considered in the rare instance in which the patient presents with combined occlusion.

Acknowledgement

Grant Medical College and Sir J.J. Group of Hospital, Mumbai, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Leibovitch I, Goldstein M, Loewenstein A, Barak A. Combined central retinal artery and vein occlusion in a patient with systemic lupus erythematosus. Rheumatology (Oxford) 2001;40:1195-6.  Back to cited text no. 1
    
2.
Parchand SM, Vijitha VS, Misra DP. Combined central retinal artery and vein occlusion in lupus. BMJ Case Rep 2017;2017. pii: bcr2016218848.  Back to cited text no. 2
    


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