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Unilateral Perivascular Infiltrates in Lupus Retinopathy

Unilateral Perivascular Infiltrates in Lupus Retinopathy Clinical Review & Education Ophthalmic Images Clinton C. Warren, MD; Mohamed G. Gendy, MD; Judy E. Kim, MD A B Figure. Funduscopic appearance of lupus retinopathy before and after treatment with systemic steroids. A, At presentation, the left eye showed widespread perivascular infiltrates, scattered intraretinal hemorrhages, cotton-wool spots, vascular sheathing, and optic nerve edema. B, Significant improvement was seen following 10 days of treatment with systemic steroids. A20-year-oldAfricanAmericanwomaninitiallypresentedwithuni- pholipid antibody testing were negative. The results of a renal biopsy lateral vision loss, fatigue, weight loss, and a malar rash. Her visual werefoundtobeconsistentwithclassVlupusmembranousglomeru- acuitywas20/20ODand20/25OS.Afunduscopicexaminationofthe lopathy.Sheimprovedclinicallybytakingintravenoussteroids(Figure, left eye revealed an unusual dendritic pattern of widespread perivas- B)andremainedquiescentwhilereceivingacombinationoforalpred- cularinfiltrates(Figure,A).Therighteyewasnormal.Aninitialworkup nisone and mycophenolate mofetil. revealed an antinuclear antibody level of greater than 8.0 IU/mL Discussion (normalrange,0.0-0.9IU/mL)andmarkedlyelevatedlevelsofSjögren The fundus findings and unilaterality suggest that there may be a syndrome antigens A and B, anti-Smith, and anti-ribonucleoprotein component of mild vascular occlusion. In addition, the atypical pat- antibodies. The results of anti–double-stranded DNA and antiphos- tern of infiltrates may represent immune complex deposition. ARTICLE INFORMATION Accepted for Publication: November 4, 2014. Role of the Funder/Sponsor: The Research to Prevent Blindness had no role in the design and Author Affiliations: Department of Conflict of Interest Disclosures: http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Ophthalmology American Medical Association

Unilateral Perivascular Infiltrates in Lupus Retinopathy

Unilateral Perivascular Infiltrates in Lupus Retinopathy

Abstract

Clinical Review & Education Ophthalmic Images Clinton C. Warren, MD; Mohamed G. Gendy, MD; Judy E. Kim, MD A B Figure. Funduscopic appearance of lupus retinopathy before and after treatment with systemic steroids. A, At presentation, the left eye showed widespread perivascular infiltrates, scattered intraretinal hemorrhages, cotton-wool spots, vascular sheathing, and optic nerve edema. B, Significant improvement was seen following 10 days of treatment with systemic steroids....
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Publisher
American Medical Association
Copyright
Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6165
eISSN
2168-6173
DOI
10.1001/jamaophthalmol.2014.5367
pmid
26067692
Publisher site
See Article on Publisher Site

Abstract

Clinical Review & Education Ophthalmic Images Clinton C. Warren, MD; Mohamed G. Gendy, MD; Judy E. Kim, MD A B Figure. Funduscopic appearance of lupus retinopathy before and after treatment with systemic steroids. A, At presentation, the left eye showed widespread perivascular infiltrates, scattered intraretinal hemorrhages, cotton-wool spots, vascular sheathing, and optic nerve edema. B, Significant improvement was seen following 10 days of treatment with systemic steroids. A20-year-oldAfricanAmericanwomaninitiallypresentedwithuni- pholipid antibody testing were negative. The results of a renal biopsy lateral vision loss, fatigue, weight loss, and a malar rash. Her visual werefoundtobeconsistentwithclassVlupusmembranousglomeru- acuitywas20/20ODand20/25OS.Afunduscopicexaminationofthe lopathy.Sheimprovedclinicallybytakingintravenoussteroids(Figure, left eye revealed an unusual dendritic pattern of widespread perivas- B)andremainedquiescentwhilereceivingacombinationoforalpred- cularinfiltrates(Figure,A).Therighteyewasnormal.Aninitialworkup nisone and mycophenolate mofetil. revealed an antinuclear antibody level of greater than 8.0 IU/mL Discussion (normalrange,0.0-0.9IU/mL)andmarkedlyelevatedlevelsofSjögren The fundus findings and unilaterality suggest that there may be a syndrome antigens A and B, anti-Smith, and anti-ribonucleoprotein component of mild vascular occlusion. In addition, the atypical pat- antibodies. The results of anti–double-stranded DNA and antiphos- tern of infiltrates may represent immune complex deposition. ARTICLE INFORMATION Accepted for Publication: November 4, 2014. Role of the Funder/Sponsor: The Research to Prevent Blindness had no role in the design and Author Affiliations: Department of Conflict of Interest Disclosures:

Journal

JAMA OphthalmologyAmerican Medical Association

Published: Jun 1, 2015

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