|Year : 2018 | Volume
| Issue : 12 | Page : 1864
Combined central retinal artery and vein occlusion as the presenting manifestation of systemic lupus erythematosus
Pritam Bawankar1, Preetam Samant1, Sayalee Lahane1, Ashish Jain1, Pooja Pathak2
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 Publication||19-Nov-2018|
Dr. Pritam Bawankar
Department of Vitreo-Retina Surgery Services, Grant Medical College and Sir J.J. Group of Hospital, Byculla, Mumbai - 400 008, Maharashtra
Source of Support: None, Conflict of Interest: None
|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 Jul 22];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., This case reminds us that SLE must be considered in the rare instance in which the patient presents with combined occlusion.
Grant Medical College and Sir J.J. Group of Hospital, Mumbai, India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
Parchand SM, Vijitha VS, Misra DP. Combined central retinal artery and vein occlusion in lupus. BMJ Case Rep 2017;2017. pii: bcr2016218848.