Bilateral optic neuritis in pediatric systemic lupus erythematosus with antiphospholipid antibody syndrome.
Bilateral optic neuritis is an extremely uncommon complication of pediatric systemic lupus erythematosus and sporadic cases are reported in the literature. The authors describe an 11-yr-old girl who presented with fever and progressively increasing pallor for 4 months, headache for 7 days, severe anemia and hepatosplenomegaly. Soon after admission, she developed rapid deterioration of vision, worsening to no perception of light with afferent pupillary defect. Fundoscopy showed bilateral optic neuritis. Investigations revealed autoimmune hemolytic anemia and thrombocytopenia. Anti-dsDNA and anti-phospholipid antibodies were positive. Magnetic resonance venography showed multiple thrombi in the cerebral venous sinuses, for which anticoagulant therapy was initiated. She was managed with intravenous methylprednisolone followed by cyclophosphamide pulse therapy for 6 months along with oral prednisolone. Though she went into remission, visual outcome has been dismal, with development of bilateral optic atrophy, and absence of perception of light.
Patra
Soumya
S
Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, 110001, India. dr_soumyapatra@rediffmail.com
Krishnamurthy
Sriram
S
Seth
Anju
A
Beri
Sarita
S
Aneja
Satinder
S
D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis / Q000628:therapy; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D002550:Cerebral Veins / Q000503:physiopathology; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008775:Methylprednisolone / Q000627:therapeutic use; D009902:Optic Neuritis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy; D014859:Warfarin / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D007166:Immunosuppressive Agents; D014859:Warfarin; D003520:Cyclophosphamide; D006493:Heparin; D011239:Prednisolone; D008775:Methylprednisolone