Bilateral optic neuritis in pediatric systemic lupus erythematosus associated with antiphospholipid antibodies and neuromyelitis optica immunoglobulin

• Published in: Journal of pediatric ophthalmology and strabismus Vol. 47 Online; no. 3; pp. e1 - 4
• Main Authors: Wei, Wenxin, Zerfoss, Erica, Ashker, Lamees, Cantore, William A
• Format: Journal Article
• Language: English
• Published: United States SLACK INCORPORATED 21.05.2010
• Subjects: Adolescent; Angiogenesis Inhibitors - therapeutic use; Antibodies; Antibodies, Antiphospholipid - blood; Antibodies, Monoclonal, Humanized - therapeutic use; Anticoagulants; Antiphospholipid Syndrome - complications; Antiphospholipid Syndrome - diagnosis; Antiphospholipid Syndrome - drug therapy; Blindness - etiology; Cyclophosphamide - therapeutic use; Female; Glucocorticoids - therapeutic use; Humans; Immunoglobulin G - blood; Immunoglobulins; Immunoglobulins, Intravenous - therapeutic use; Immunosuppressive Agents - therapeutic use; Light; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - drug therapy; Magnetic Resonance Imaging; Medical laboratories; Nervous system; Neurological disorders; Neuromyelitis Optica - complications; Neuromyelitis Optica - diagnosis; Neuromyelitis Optica - immunology; Optic nerve; Optic Neuritis - diagnosis; Optic Neuritis - drug therapy; Optic Neuritis - etiology; Pathogenesis; Patients; Pediatrics; Ranibizumab; Rheumatology; Spinal cord; Thrombosis; Visual Acuity
• ISSN: 0191-3913; 1938-2405
• DOI: 10.3928/01913913-20100324-04

The authors report a case of a 16-year-old girl with a history of systemic lupus erythematosus who developed bilateral acute optic neuritis. Systemic lupus erythematosus can present with a vast array of neurological and ophthalmic complications, with optic neuritis being a rare but devastating manifestation and the major cause of blindness in these patients. The patient presented with an acute unilateral visual deficit that progressed to bilateral visual loss with no light perception over the course of days. Treatment included high-dose steroids, cyclophosphamide, intravenous immunoglobulin, and eventually rituximab. Furthermore, the patient was also seropositive for both antiphospholipid and neuromyelitis optica antibodies, which can have implications on prognosis and treatment options.