Retinal lesions occur frequently in systemic lupus erythematosus, however, they rarely cause visual impairment. A patient btinded by severe lupus retinopathy is described, and the pertinent literature is reviewed.Systemic lupus erythematosus not infrequently causes retinopathy (1-4). Subsequent visual impairment, however, is not common and blindness due to lupus retinopathy is rare (2). Clinically observed retinal lesions include cotton wool exudates in 9 4 4 % of cases (2, 3, 5) and superficial flame-shaped, or preretinal hemorrhages in about 10% (6). Less common are retinal arteritis and phlebitis, which when severe may lead to perivascular sheathing and fibrosis (7). Papilledema with optic atrophy and retinal detachment are seen only rarely and most often terminally (6,7).Severe retinopathy was more commonly seen in the presteroid era and, at present, occurs most frequently in patients whose generalized lupus activity has not been well controlled. It is of interest then to report a case of probable lupus erythematosus in which the eyes were involved early in the course and were the organs most severely affected by the disease process.
CASE HISTORYThe patient was a 23-year-old black woman, well until one month prior to admission when she developed a malar eruption, anorexia, weight loss, malaise, myalgias, low grade fever and fatigue. She denied a history of arthritis, chest pain, headaches, abdominal pain or change in bowel habits. She had used oral contraceptives for three years prior to the onset of her illness.Initial examination revealed a thin black woman in minimal physical distress, with a blood pressure of 110/60 mmHg, regular pulse of 84, and oral temperature of 101°F. Other pertinent findings included a discoidal skin eruption in a malar distribution; medullated nerve fibers in the left eye; bilateral, tender, easily movable 3 X 3 cm axillary lymph nodes, and several small petechiae on the right foot.Laboratory findings included a persistent pancytopenia with WBC of 2,800-3,500/cu mm, hematocrit of 33-38%, and platelet counts between 75,000 and 160,OOO/cu mm. ESR on multiple occasions was between 55-110 mm/hr. Urinalyses showed 3-25 WBC/hpf, 3+ proteinuria, occasional RBCs and no casts. A 24-hour urine contained 600 mg of protein.Total serum protein was 8.2 8% with an albumin of 3.4 g%. Serum protein electrophoresis showed a nonspecific y globulin elevation. Antinuclear antibody (using mouse liver as the substrate), was 4+ with a speckled pattern, LE preparations were negative X 5, serum complements were 173 and 186 hemolytic units (normal greater than 150 hemolytic units) : latex fixation test was negative. Serum electrolytes, CO,, fasting blood sugar, creatinine clearance, SGOT, SGPT, Ca and P were normal. Serology was nonreactive and the EKG was within normal limits. T h e chest X-ray demonstrated mini-
