Rare and Unusual Choroidal Abnormalities in a Patient with Systemic Lupus Erythematosus
A 42-year-old woman complaining of transient blindness in her left eye was referred to our hospital. The patient had a history of SLE and central retinal artery occlusion in her right eye that occurred at the age of 33 years. On initial examination, she had a best-corrected visual acuity of 1.2 in the left eye and no light perception in the right eye. Ocular pressures and anterior segments were normal (fig. ). Fundus examination showed no specific retinochoroidal abnormalities with the exception of optic disc atrophy due to central retinal artery occlusion in her right eye (fig. ) and a peripapillary small hemorrhage in her left eye (fig. ). Fluorescein angiography revealed no dye leakage and pooling (fig. ). However, NIR (Heidelberg Retina Angiograph 2, Heidelberg Engineering, Heidelberg, Germany) showed multiple bright patchy lesions in the choroid of the posterior pole and the mid-periphery of the fundus in both eyes (fig. ). OCT (RS-3000, NIDEK, Gamagori, Japan) images of these lesions revealed irregular, hyperreflective choroidal foci (fig. ).\nAdministration of oral steroids was continued and her laboratory values were as follows: hemoglobin 9.1 g/dl, hematocrit 29.3%, WBC count 6,900/mm3 and platelet count 223,000/mm3. No atypical cells were found during a peripheral blood smear. C-reactive protein was 0.97 mg/dl (normal <0.06 mg/dl). Hepatic and renal function tests and electrolytes were within normal limits. Urinalysis was normal. C3 and C4 complement fractions were 64 and 11 mg/dl, respectively (normal values are 86–160 and 17–45 mg/dl, respectively). Anti-double-stranded DNA antibody was 125.1 IU/ml (normal <12.0 IU/ml). Cranial magnetic resonance imaging findings were unremarkable.