Central vision loss in a 44-year-old woman

Abstract

Central vision loss in a 44-year-old womanA 44-year-old woman presented to the emergency department following 1 week of sudden, painless, central vision loss in the left eye and 1 day of headache preceded by intermittent fl oaters and fl ashing lights. The headache was a dull, aching pain in the left temple. For the preceding 2 months, she had been treated by an outside ophthalmologist for bilateral anterior uveitis, unresponsive to topical prednisolone. She additionally noted recent hair loss and a rash on the palms. She denied light sensitivity, eye pain, trauma, blurred vision, fever, chills, chest pain, shortness of breath, abdominal pain, nausea, dizziness, blurred vision, or syncope prior to presentation.Medical comorbidities included 15 years of systemic lupus erythematosus (SLE) and antiphospholipid syndrome that fi rst manifested as a cerebrovascular accident (CVA). Serum analysis at time of SLE diagnosis revealed strongly positive antinuclear antibodies, elevated Sjögren syndrome antibodies, double-stranded DNA, beta-2-glycoprotein immunoglobulin G, anticardiolipin immunoglobulin G, and lupus anticoagulant.The patient's presentation of vascular thrombosis with positive antiphospholipid antibodies met the Sydney criteria for diagnosis of triple-positive antiphospholipid antibody syndrome. Following appropriate anticoagulation, she experienced occasional skin rashes, Raynaud phenomenon, and sicca symptoms. Other medical comorbidities included migraines and focal epilepsy. Her regular medications included prednisone 7.5 mg daily, methotrexate, hydroxychloroquine, warfarin, and topiramate. She was sexually active. ■ INITIAL EVALUATION AND MANAGEMENTAt presentation, the patient's temperature was 99.1°F (37.3°C), heart rate 80 beats per minute, blood pres-