Optic Neuropathy and Chiasmopathy in the Diagnosis of Systemic Lupus Erythematosus.
Siatkowski, R. Michael MD; Scott, Ingrid U. MD; Verm, Alan M. MD; Warn, Ann A. MD; Farris, Bradley K. MD; Strominger, Mitchell B. MD; Sklar, Evelyn M.L. MD
Journal of Neuro-Ophthalmology.
21(3):193-198, September 2001.
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Purpose: To report the clinical presentation of acute visual loss in six patients who were ultimately diagnosed with systemic lupus erythematosus (SLE).
Methods: Retrospective case series.
Results: All patients had a positive antinuclear antibody and elevated anti-double stranded DNA titers. Five of six patients demonstrated gadolinium enhancement of the optic nerve and/or chiasm on magnetic resonance imaging (MRI). Most patients showed initial improvement after treatment with high-dose systemic corticosteroids, but five experienced recrudescences during steroid taper, requiring further treatment with immunosuppressive or cytotoxic medications.
Conclusions: Visual loss owing to optic neuropathy or chiasmopathy may be the presenting sign of SLE or the event that leads to this diagnosis. Gadolinium-enhanced MRI is useful for identifying anterior visual pathway lesions in these patients. Corticosteroids are effective in the treatment of this condition; however, relapses requiring further treatment are common.
(C) 2001 Lippincott Williams & Wilkins, Inc.