Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
Pediatr Rheumatol Online J. 2013 Jun 4;11(1):25. doi: 10.1186/1546-0096-11-25.
We report two pediatric female patients with systemic lupus erythematosus (SLE) who presented with decreased vision. Both patients were found to have retinal vasculitis and occlusive disease. The first patient also presented with vitreous hemorrhage and later non-arteritic ischemic optic neuropathy. She was treated with panretinal photocoagulation and steroid therapy and later in her disease course was treated with rituximab and cyclophosphamide. Her vision remained decreased. The second patient was treated with rituximab and monthly cyclophosphamide infusions early in her disease course, and her vision improved dramatically. The difference in the presentations and outcomes of these two pediatric patients with SLE highlights the spectrum of severity of SLE retinopathy. We suggest that early recognition of disease and early intervention with B-cell depletion therapy in addition to a traditional cytotoxic agent should be considered in pediatric patients with SLE and occlusive retinopathy.
我们报告了两名患有系统性红斑狼疮 (SLE) 的儿科女性患者，她们均出现视力下降。两名患者均被发现存在视网膜血管炎和闭塞性疾病。第一例患者还出现了玻璃体出血，后来又发生了非动脉炎性缺血性视神经病变。她接受了全视网膜光凝和类固醇治疗，后来在疾病过程中接受了利妥昔单抗和环磷酰胺治疗。她的视力仍然下降。第二例患者在疾病早期接受了利妥昔单抗和每月环磷酰胺输注治疗，她的视力显著改善。这两名患有 SLE 的儿科患者临床表现和结局的差异突出了 SLE 视网膜病变严重程度的范围。我们建议，对于患有 SLE 和闭塞性视网膜病变的儿科患者，应早期识别疾病，并在传统细胞毒性药物之外，早期考虑采用 B 细胞耗竭疗法进行干预。
