背景:报告一种罕见的脉络膜新生血管相关色素上皮病的发生是系统性红斑狼疮的首发表现。
方法:一位54岁的女性,没有既往病史,由于右眼视力突然下降到20/80,因此寻求第二种意见。裂隙灯检查正常。眼底检查显示黄斑区存在视网膜下出血。包括光学相干断层扫描和荧光素血管造影在内的眼底成像显示与脉络膜新生血管(CNV)相关的多灶性视网膜色素上皮病变。患者在2周前接受了贝伐单抗的玻璃体内注射。决定通过两次额外的贝伐单抗注射来完成负荷剂量方案,第一次注射是在她的演讲后2周进行的。两周后,病人报告说她的脸颊上有皮疹,关节疼痛,还有紫癜.系统性检查显示ANA呈阳性,抗心磷脂抗体,补体水平下降,抗组蛋白抗体阴性。根据“系统性狼疮国际合作诊所”标准,这导致了系统性红斑狼疮(SLE)的诊断。患者用50mg泼尼松龙治疗,然后逐渐减少。第三次注射后1个月,显示视网膜下液的总分辨率,视力改善至20/20。随访期间未观察到复发。
结论:根据眼底检查和影像学检查的结果,全身症状和血液检查,我们推测与脉络膜新生血管相关的色素上皮病与脉络膜水平的血管闭塞性疾病有关,脉络膜水平可能是SLE血管病变的一部分.据我们所知,这是首例以色素上皮病变和CNV为主要表现的SLE.
BACKGROUND: To report a rare occurrence of pigment epitheliopathy associated with choroidal neovasculization as a first manifestation of systemic lupus erythematosus.
METHODS: A 54-year-old female, with no prior medical history, sought a second opinion due to sudden drop in vision in her right eye to 20/80. Slit lamp examination was normal. Fundus examination revealed the presence of a subretinal hemorrhage in the macular area. Fundus imaging including optical coherence tomography and fluorescein angiography showed multifocal retinal pigment epitheliopathy associated with choroidal neovascularization (CNV). The patient had received an intravitreal injection of Bevacizumab 2 weeks ago. It was decided to complete the loading dose regimen with two additional Bevacizumab injections, and the first injection was done 2 weeks after her presentation. Two weeks later, the patient reported a rash on her cheeks, painful joints, and purpura. Systemic workup revealed positive ANA, anti-cardiolipin antibodies, and decreased complement levels, with negative anti-histone antibodies. This led to the diagnosis of systemic lupus erythematosus (SLE) based on the \"Systemic Lupus International Collaborating Clinics\" criteria. The patient was treated with 50 mg of prednisolone which was then tapered. 1 month after the third injection, an showed a total resolution of the sub-retinal fluid with an improvement of vision to 20/20. No recurrence was observed during follow-up.
CONCLUSIONS: Based on the findings from the fundus exam and imaging, systemic symptoms and the blood work-up, we postulate that the pigment epitheliopathy associated with choroidal neovascularization was related to the vaso-occlusive disease at the level of the choroid that can be part of SLE vasculopathy. To our knowledge, this represents the first
case in which pigment epitheliopathy and CNV were the primary manifestations of SLE.