Liles Caleb, Warner Chase, Warwar Ronald
Ohio University Heritage College of Osteopathic Medicine, Athens, OH, United States.
Department of Ophthalmology, Grandview Medical Center, Dayton, OH, United States.
Am J Ophthalmol Case Rep. 2020 Oct 10;20:100967. doi: 10.1016/j.ajoc.2020.100967. eCollection 2020 Dec.
Systemic sclerosis (SSc) is characterized by multi-system inflammation and fibrosis. Ophthalmologists must be aware of the uncommon ocular features of SSc to secure the diagnosis.
Here we report the rare occurrence of bilateral cotton wool spots in an 86-year-old woman with SSc/lupus overlap syndrome presenting with a history of chronic obstructive pulmonary disease, gastroesophageal reflux disease, polymyalgia rheumatica, scalp tenderness, and right jaw pain on chewing. Fundoscopy showed diffuse bilateral cotton wool spots that prompted the diagnosis of SSc/lupus overlap syndrome.
The confluence of patient symptoms was disguised as separate diseases, but the funduscopic finding of cotton wool spots in a patient without known risk factors prompted further investigation and the correct diagnosis. She was started on immunosuppressant therapy but unfortunately died four months later after developing right heart failure.
The differential diagnosis for bilateral cotton wool spots should include autoimmune processes such as SSc and systemic lupus erythematosus and may represent an early sign that can help direct treatment.
系统性硬化症（SSc）的特征是多系统炎症和纤维化。眼科医生必须了解SSc不常见的眼部特征以确保诊断。
我们在此报告一名86岁患有SSc/狼疮重叠综合征的女性罕见地出现双侧棉絮斑，该患者有慢性阻塞性肺疾病、胃食管反流病、风湿性多肌痛、头皮压痛以及咀嚼时右颌疼痛的病史。眼底镜检查显示双侧弥漫性棉絮斑，这促使诊断为SSc/狼疮重叠综合征。
患者症状的合并被伪装成多种不同疾病，但在无已知危险因素的患者中眼底镜检查发现棉絮斑促使进一步检查并得出正确诊断。她开始接受免疫抑制治疗，但不幸的是在出现右心衰竭四个月后死亡。
双侧棉絮斑的鉴别诊断应包括自身免疫性疾病，如SSc和系统性红斑狼疮，且可能代表有助于指导治疗的早期迹象。
