Lupus Nephritis with Visual Field Defect Secondary to Hypertensive Retinopathy: A Case Report
- Author:
Hor SM
;
Norshamsiah MD
;
Mushawiahti M
;
Hazlita MI
- Publication Type:Case report
- Keywords:
hydroxychloroquine;
hypertensive retinopathy, lupus nephriti;
scotoma;
visual fields
- From:Journal of Surgical Academia
2017;7(2):32-36
- CountryMalaysia
- Language:English
-
Abstract:
A 23-year-old lady presented with both eye progressive painless blurring of vision for two weeks in 2011. Prior to
that she had malar rash, hair loss, photosensitivity and bilateral leg swelling. Ocular examination showed that visual
acuity on the right was 6/60 and on the left was 6/24. Both optic disc were swollen with extensive peripapillary
cotton wool spot (CWS), flame shape haemorrhages, dilated and tortuous vessels with macular oedema. Systemic
examination revealed blood pressure of 176/111 mmHg, malar rash and alopecia. Diagnosis of grade 4 hypertensive
retinopathy secondary to SLE was made. The diagnosis was confirmed by positive ANA/ dsDNA, low C3/ C4 and
renal biopsy showed lupus nephritis. She was treated with oral prednisolone, hydroxychloroquine and cyclosporin A.
Throughout the monitoring for hydroxychloroquine toxicity, vision over both eyes were 6/9, but serial visual fields
showed non-progressive left superior and inferior scotoma while right eye showed inferior scotoma. The intraocular
pressure was normal with pink optic disc and cup disc ratio of 0.3. Optical coherence tomography (OCT) showed
temporal and nasal retinal nerve fiber layer thinning bilaterally. However, macula OCT, fundus fluorescein
angiography and autofluorescence were normal. The visual field defect was concluded secondary to CWS indicating
microinfarction of the retinal nerve fiber secondary to previous hypertensive retinopathy. Non-progressive visual
field defects may occur after the appearance of CWS in hypertensive retinopathy and it should not be overlooked
when diagnosing glaucoma or hydroxychloroquine toxicity.
