Yao Yuan, Wang Hai-Xia, Liu Li-Wei, Ding Yue-Ling, Sheng Jiao-E, Deng Xiao-Hu, Liu Bin
Department of Rheumatology Immunology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China.
World J Clin Cases. 2022 Jul 6;10(19):6520-6528. doi: 10.12998/wjcc.v10.i19.6520.
Systemic lupus erythematosus (SLE), characterized by the production of autoantibodies and widespread deposition of immune complexes, predominantly affects women of childbearing age. More than one-third of SLE patients present ocular manifestations. Choroidal disease is currently not completely understood, and its precise differentiation from central serous chorioretinopathy is rarely achieved. To date, no more than 60 patients with choroidal involvement have been reported.
A 37-year-old Chinese woman experienced decreased visual acuity bilaterally, accompanied by increasing periorbital swelling and severe conjunctival chemosis. Decreased breath sounds in both bases were detected auscultation, as well as pitting edema in both ankles. SLE and lupus nephritis were diagnosed based on serositis, renal disorder, leukopenia and positive anti-Smith and anti-nuclear antibodies. Lupus choroidopathy was diagnosed based on ocular presentation and imaging. The patient was treated with systemic corticosteroids, spironolactone, hydroxychloroquine (HCQ), mycophenolate mofetil (MMF), and intravenous immunoglobulin. After 4 wk of hospitalization, the patient was discharged. Indocyanine green angiography showed no leakage from choroidal vessels, and ocular coherence tomography detected low amounts of subretinal fluid right before discharge. The patient was prescribed oral methylprednisolone, HCQ, and MMF. Two months after the first visit, ophthalmological examination revealed a visual acuity of 20/20 bilaterally, and SLE disease activity was well controlled; her symptoms disappeared completely.
Here we presented a case of lupus choroidopathy, successfully treated with systemic corticosteroids, and discussed previously reported cases, focusing on differential diagnosis with a central serous chorioretinopathy.
系统性红斑狼疮（SLE）以自身抗体产生和免疫复合物广泛沉积为特征，主要影响育龄女性。超过三分之一的SLE患者出现眼部表现。脉络膜疾病目前尚未完全了解，与中心性浆液性脉络膜视网膜病变的精确鉴别也很少能做到。迄今为止，报道的脉络膜受累患者不超过60例。
一名37岁中国女性双侧视力下降，伴有眶周肿胀加重和严重结膜水肿。听诊双肺底部呼吸音减弱，双侧踝关节有凹陷性水肿。根据浆膜炎、肾脏疾病、白细胞减少以及抗史密斯抗体和抗核抗体阳性诊断为SLE和狼疮性肾炎。根据眼部表现和影像学检查诊断为狼疮性脉络膜病变。患者接受了全身用糖皮质激素、螺内酯、羟氯喹（HCQ）、霉酚酸酯（MMF）和静脉注射免疫球蛋白治疗。住院4周后出院。吲哚菁绿血管造影显示脉络膜血管无渗漏，出院前光学相干断层扫描检测到少量视网膜下液。给患者开了口服甲泼尼龙、HCQ和MMF。首次就诊两个月后，眼科检查显示双侧视力均为20/20，SLE疾病活动得到良好控制；她的症状完全消失。
我们在此报告一例成功用全身糖皮质激素治疗的狼疮性脉络膜病变病例，并讨论了先前报道的病例，重点是与中心性浆液性脉络膜视网膜病变的鉴别诊断。
