Optic neuropathy and chiasmopathy in the diagnosis of systemic lupus erythematosus.
OBJECTIVE
To report the clinical presentation of acute visual loss in six patients who were ultimately diagnosed with systemic lupus erythematosus (SLE).


METHODS
Retrospective case series.


RESULTS
All patients had a positive antinuclear antibody and elevated anti-double stranded DNA titers. Five of six patients demonstrated gadolinium enhancement of the optic nerve and/or chiasm on magnetic resonance imaging (MRI). Most patients showed initial improvement after treatment with high-dose systemic corticosteroids, but five experienced recrudescences during steroid taper, requiring further treatment with immunosuppressive or cytotoxic medications.


CONCLUSIONS
Visual loss owing to optic neuropathy or chiasmopathy may be the presenting sign of SLE or the event that leads to this diagnosis. Gadolinium-enhanced MRI is useful for identifying anterior visual pathway lesions in these patients. Corticosteroids are effective in the treatment of this condition; however, relapses requiring further treatment are common.
Siatkowski
R M
RM
Dean A. McGee Eye Institute, Department of Ophthalmology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA. rmichael-siatkowski@ouhsc.edu
Scott
I U
IU
Verm
A M
AM
Warn
A A
AA
Farris
B K
BK
Strominger
M B
MB
Sklar
E M
EM
D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000032:analysis; D001766:Blindness / Q000473:pathology; D004247:DNA / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009897:Optic Chiasm / Q000187:drug effects / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000188:drug therapy; D012189:Retrospective Studies; D014792:Visual Acuity; D014795:Visual Pathways / Q000473:pathology
D000974:Antibodies, Antinuclear; D005938:Glucocorticoids; D004247:DNA; D008775:Methylprednisolone