A case of severe choroidal detachment in both eyes due to systemic lupus erythematosus

Purpose: We report a case of severe choroidal detachments (CDs) in both eyes caused by systemic lupus erythematosus (SLE). Observations: The patient was a 50-year-old woman who presented with conjunctival edema in both eyes, visual dysfunction, and generalized fatigue. At the first visit, the best c...

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Main Authors: Yudai Furukawa, Sho Yokoyama, Yoshihito Tanaka, Masanari Kodera, Tatsushi Kaga
Format: Article
Language:English
Published: Elsevier 2020-09-01
Series:American Journal of Ophthalmology Case Reports
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2451993620301559
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author Yudai Furukawa
Sho Yokoyama
Yoshihito Tanaka
Masanari Kodera
Tatsushi Kaga
author_facet Yudai Furukawa
Sho Yokoyama
Yoshihito Tanaka
Masanari Kodera
Tatsushi Kaga
author_sort Yudai Furukawa
collection DOAJ
description Purpose: We report a case of severe choroidal detachments (CDs) in both eyes caused by systemic lupus erythematosus (SLE). Observations: The patient was a 50-year-old woman who presented with conjunctival edema in both eyes, visual dysfunction, and generalized fatigue. At the first visit, the best corrected visual acuity (BCVA) was 20/70 OD and 20/70 OS, and the intraocular pressure (IOP) was 22 mmHg OD and 27 mmHg OS. She had serous retinal detachments (SRDs), CDs, ciliary dissections, and a shallow anterior chamber with partial angle closure in both eyes. Systemic findings included hypoalbuminemia, pleural fluid, generalized fatigue, and brown papules on the back and both legs. First, we suspected Vogt-Koyanagi-Harada disease and administered two courses of methylprednisolone pulse therapy, but the CDs in both eyes gradually deteriorated and worsened to the extent that the optic nerve in both eyes could not be observed, and the BCVA deteriorated to 20/200 OD and 6/200 OS. Further multidisciplinary evaluations for diagnosing collagen diseases revealed vasculitis in the skin histopathology examination, positive results for anti-double stranded DNA antibody and anti-SS-A antibody, and hypocomplementemia in the blood examination, and she was diagnosed with severe SLE in the dermatology department. After administration of high dose intravenous γ-globulin therapy, albumin infusion, and intravenous cyclophosphamide pulse therapy, the SRDs and severe CDs improved along with improvement in hypoalbuminemia, pleural fluid, and generalized fatigue. Moreover, the shallow anterior chamber and high IOP improved to normal in both eyes. The CDs and SRDs completely disappeared, and the BCVA improved to 20/13 OU 6 months after the SLE therapy. Conclusion and importance: In patients with observed SRDs and CDs accompanying hypoalbuminemia, it is necessary to consider collagen diseases such as SLE.
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spelling doaj.art-92c1c270ebc44ed7b7fd62ff4acb85c82022-12-22T00:26:21ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362020-09-0119100829A case of severe choroidal detachment in both eyes due to systemic lupus erythematosusYudai Furukawa0Sho Yokoyama1Yoshihito Tanaka2Masanari Kodera3Tatsushi Kaga4Department of Ophthalmology, Daiyukai General Hospital, Ichinomiya, JapanDepartment of Ophthalmology, Japan Community Health care Organization Chukyo Hospital, Nagoya, Japan; Corresponding author. Japan Community Health care Organization Chukyo Hospital, 1-1-10 Sanjo, Minamiku, Nagoya, Aichi, 457-8510, Japan.Department of Dermatology, Japan Community Health care Organization Chukyo Hospital, Nagoya, JapanDepartment of Dermatology, Japan Community Health care Organization Chukyo Hospital, Nagoya, JapanDepartment of Ophthalmology, Japan Community Health care Organization Chukyo Hospital, Nagoya, JapanPurpose: We report a case of severe choroidal detachments (CDs) in both eyes caused by systemic lupus erythematosus (SLE). Observations: The patient was a 50-year-old woman who presented with conjunctival edema in both eyes, visual dysfunction, and generalized fatigue. At the first visit, the best corrected visual acuity (BCVA) was 20/70 OD and 20/70 OS, and the intraocular pressure (IOP) was 22 mmHg OD and 27 mmHg OS. She had serous retinal detachments (SRDs), CDs, ciliary dissections, and a shallow anterior chamber with partial angle closure in both eyes. Systemic findings included hypoalbuminemia, pleural fluid, generalized fatigue, and brown papules on the back and both legs. First, we suspected Vogt-Koyanagi-Harada disease and administered two courses of methylprednisolone pulse therapy, but the CDs in both eyes gradually deteriorated and worsened to the extent that the optic nerve in both eyes could not be observed, and the BCVA deteriorated to 20/200 OD and 6/200 OS. Further multidisciplinary evaluations for diagnosing collagen diseases revealed vasculitis in the skin histopathology examination, positive results for anti-double stranded DNA antibody and anti-SS-A antibody, and hypocomplementemia in the blood examination, and she was diagnosed with severe SLE in the dermatology department. After administration of high dose intravenous γ-globulin therapy, albumin infusion, and intravenous cyclophosphamide pulse therapy, the SRDs and severe CDs improved along with improvement in hypoalbuminemia, pleural fluid, and generalized fatigue. Moreover, the shallow anterior chamber and high IOP improved to normal in both eyes. The CDs and SRDs completely disappeared, and the BCVA improved to 20/13 OU 6 months after the SLE therapy. Conclusion and importance: In patients with observed SRDs and CDs accompanying hypoalbuminemia, it is necessary to consider collagen diseases such as SLE.http://www.sciencedirect.com/science/article/pii/S2451993620301559Systemic lupus erythematosusChoroidal detachmentSerous retinal detachmentProtein-losing gastroenteropathyHypoalbuminemiaVascular permeability
spellingShingle Yudai Furukawa
Sho Yokoyama
Yoshihito Tanaka
Masanari Kodera
Tatsushi Kaga
A case of severe choroidal detachment in both eyes due to systemic lupus erythematosus
American Journal of Ophthalmology Case Reports
Systemic lupus erythematosus
Choroidal detachment
Serous retinal detachment
Protein-losing gastroenteropathy
Hypoalbuminemia
Vascular permeability
title A case of severe choroidal detachment in both eyes due to systemic lupus erythematosus
title_full A case of severe choroidal detachment in both eyes due to systemic lupus erythematosus
title_fullStr A case of severe choroidal detachment in both eyes due to systemic lupus erythematosus
title_full_unstemmed A case of severe choroidal detachment in both eyes due to systemic lupus erythematosus
title_short A case of severe choroidal detachment in both eyes due to systemic lupus erythematosus
title_sort case of severe choroidal detachment in both eyes due to systemic lupus erythematosus
topic Systemic lupus erythematosus
Choroidal detachment
Serous retinal detachment
Protein-losing gastroenteropathy
Hypoalbuminemia
Vascular permeability
url http://www.sciencedirect.com/science/article/pii/S2451993620301559
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