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Purtscher-Like Retinopathy During a Systemic Lupus Erythematosus Flare: A Case Report
Purpose: To report a case of bilateral Purtscher-like retinopathy occurring during an acute systemic lupus erythematosus (SLE) flare, highlighting its clinical presentation, multimodal imaging findings, and outcome.
Case Report: A 21-year-old woman with established SLE, receiving long-term oral corticosteroids and hydroxychloroquine, was hospitalized for a systemic flare characterized by migratory inflammatory arthralgia, mild hemoptysis, and deterioration in general condition. During hospitalization, she developed sudden bilateral visual loss. Best-corrected visual acuity was 2/10 in the right eye and 1/10 in the left eye. Anterior segment examination was unremarkable, without ocular inflammation. Fundus examination revealed bilateral superficial retinal hemorrhages, cotton-wool spots, and peripapillary retinal whitening consistent with Purtscher flecken. Macular optical coherence tomography demonstrated subfoveal serous retinal detachment, macular edema, and thickening of the interpapillomacular retina. Fluorescein angiography showed masking corresponding to retinal hemorrhages and late macular leakage. Laboratory investigations revealed severe thrombocytopenia (26,000/mm³), proteinuria exceeding 0.5, and decreased C3 and C4 levels. Systemic assessment identified intra-alveolar hemorrhage and small pleuropericardial effusions. The clinical and imaging findings supported the diagnosis of bilateral Purtscher-like retinopathy associated with active SLE.
Management and Outcome: The patient received intravenous corticosteroid pulses for the systemic flare and two intravitreal anti-vascular endothelial growth factor injections in each eye. Follow-up showed progressive regression of retinal hemorrhages and cotton-wool spots, with resolution of macular edema and subfoveal serous retinal detachment on optical coherence tomography. At three months, visual acuity had improved to 8/10 in both eyes, alongside systemic clinical improvement.
Conclusion: Purtscher-like retinopathy is a rare but potentially vision-threatening manifestation of active SLE. Sudden visual loss in this context warrants urgent ophthalmological assessment and multimodal retinal imaging. Prompt recognition and coordinated management of ocular and systemic disease may contribute to favorable visual recovery. However, the respective contributions of systemic corticosteroids and intravitreal anti-VEGF therapy cannot be distinguished in this case.
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