Steroid-responsive Purtscher-like retinopathy associated with macular edema in systemic lupus erythematosus: a case report

Purpose To report a case of Purtscher-like retinopathy (PLR) associated with macular edema in a young person with systemic lupus erythematosus (SLE) whose vision was restored with a systemic corticosteroid regimen and to highlight the rare and vision-threatening complication of SLE. Method Case report. Results A 27-year-old female without significant ophthalmological history who had stopped taking azathioprine and methylprednisolone for her SLE presented with sudden painless unilateral vision loss (best-corrected visual acuity [BCVA] RE: 1 m CF, LE: 20/20). Fundus examination revealed bilateral Purtscher-flecken and cotton wool spots, while optical coherence tomography (OCT) identified intra- and subretinal fluid representing macular edema with paracentral acute middle maculopathy (PAMM) on the right eye. The findings led to PLR diagnosis, and the patient received IV methylprednisolone with tapering. Five months after initial encounter, the patient’s vision recovered (BCVA RE: 20/30, LE: 20/20) and OCT showed resolution of the pathology. Conclusion While PLR is rarely found in people with SLE, it should be considered as a differential diagnosis in people with SLE presenting with sudden vision loss due to the condition being easy to diagnose clinically and its prompt treatment using corticosteroids may restore the vision loss and resolve the retinal pathology.