Secondary acute angle closure attack as an initial presentation of a novel type of systemic lupus erythematosus

• Published in: Lupus Vol. 28; no. 13; pp. 1594 - 1597
• Main Authors: Sun, H -S, Kong, X -Y, Bai, Y -Y, Li, M, Hu, N -W
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-11-2019; Sage Publications Ltd
• Subjects: Acuity; Adult; Anti-DNA antibodies; Antinuclear antibodies; Choroid Diseases - diagnosis; Choroid Diseases - etiology; Drug therapy; Edema; Eyelid; Female; Glaucoma, Angle-Closure - diagnosis; Glaucoma, Angle-Closure - etiology; Hardware reviews; Humans; Immunosuppressive agents; Immunosuppressive Agents - administration & dosage; LCDs; Liquid crystal displays; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - drug therapy; Polyserositis; Proteinuria; Steroid hormones; Steroids - administration & dosage; Systemic lupus erythematosus; Visual Acuity; secondary acute angle closure; choroidopathy; Systemic lupus erythematosus
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203319882764

Background
We report a rare case of secondary acute angle closure attack because of lupus choroidopathy and accompanying polyserositis, as an initial presentation of a novel type of systemic lupus erythematosus in a 44-year-old woman.
Case presentation
The patient complained of eyelid oedema and chemosis with bilateral severe loss of visual acuity. Systemic lupus erythematosus was diagnosed based on malar rash, polyserositis, proteinuria and positive antibody titers for antinuclear antibodies, anti-DNA, antinucleosome antibodies and ribosomal RNP. Subsequently, secondary bilateral acute angle closure caused by choroidal effusions with lupus choroidopathy was diagnosed. A month after steroid and immunosuppressive drug therapy, the patient’s intraocular pressure and visual acuity returned to normal. During the subsequent year, the secondary acute angle closure did not recur and polyserositis remained under control.
Conclusions
Bilateral, secondary acute angle closure attack due to SLE choroidopathy can be an initial presentation of SLE, which is often accompanied by polyserositis. Prompt and aggressive high doses of steroids and immunosuppressive therapy are strongly recommended.