Zeitschrift für klinische und experimentelle Ophthalmologie
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Stellar Neuroretinitis Revealing Systemic Lupus Erythematosus without Antiphospholopid Syndrome

Kawtar Zaoui, Youssouf Benmoh, Ahmed Bourazza and Karim Reda

Introduction: Systemic Lupus Erythematosus (SLE) is an autoimmune systemic disease with multiple faces, secondary to auto-reacting antibodies targeting nuclear antigen. The optic nerve involvement is reported in less than 1% of SLE, dominated by optic neuritis and optic ischemic neuropathy. neuroretinitis is defined as an inflammation of optic nerve and neural retina. We report a rare case of neuroretinitis as revealing form of SLE in young man.
Case report: 14 y old teenager boy, previously healthy, presented one month before his admission, rapidly progressive bilateral visual loss with no associated signs. Visual acuity evaluation revealed visual loss estimated to 2/10 right eye and 3/10 left eye with correction. Eye fundus objectified bilateral stellar macular with intermacularoptic disc exudates and moderate papillar pallor. The macular OCT found exudates in the plexiform layer of the retina. Other paraclinical test found bicytopenia with positive antinuclear and anti-DNA antibody; without antipospholipid antibody. The patient underwent corticotherapy with favourable evolution.
Discussion: Neuroretinitis did not figure as usual cause of visual loss in SLE; moreover it has been very rarely reported as a revealing form of SLE. The exact pathogenesis behind neuroretinitis in SLE stays unknown. Sudden onset of unilateral painless loss of vision is the typical clinical presentation of neuroretinitis. Several etiologies may lead to neuroretinitis, dominated by infectious disease (bartonellosis, borreliosis, syphilis, herpes, hepatitis, HIV, CMV, Varicelle, EBV, Toxoplasmosis, Tuberculosis). Also neuroretinitis may be idiopathic. Concerning therapy, no clear guidelines are reported in neuroretinitis occurring in SLE. The visual prognosis is excellent with above 90% cases achieving a final visual acuity.
Conclusion: We learn from this case, that neuroretinitis may be the revealing form of SLE. This suggest the need of revision of SLE criterion, especially that neuroretinitis is a part of severe form.