Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6520-6528
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6520
Acute choroidal involvement in lupus nephritis: A case report and review of literature
Yuan Yao, Hai-Xia Wang, Li-Wei Liu, Yue-Ling Ding, Jiao-E Sheng, Xiao-Hu Deng, Bin Liu
Yuan Yao, Bin Liu, Department of Rheumatology Immunology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Hai-Xia Wang, Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Li-Wei Liu, Department of Rheumatology Immunology, The People Hospital of Nanpi Country, Cangzhou 061000, Hebei Province, China
Yue-Ling Ding, Department of Hematology, The People Hospital of Dingzhou Country, Baoding 071000, Hebei Province, China
Jiao-E Sheng, Department of Rheumatology Immunology, Minda Hospital of Hubei Minzu University, Enshi 445000, Hubei Province, China
Xiao-Hu Deng, Department of Rheumatology Immunology, Chinese PLA General Hospital, Beijing 100000, China
Author contributions: Yao Y and Wang HX conceived and coordinated the study, designed, performed and analyzed the experiments, wrote the paper; Liu LW, Ding YL, Sheng JE, Deng XH and Liu B carried out the data collection, data analysis, and revised the paper; all authors reviewed the results and approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Liu, MD, Doctor, Department of Rheumatology Immunology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266003, Shandong Province, China. binliu72314@163.com
Received: September 2, 2021
Peer-review started: September 2, 2021
First decision: December 9, 2021
Revised: January 19, 2022
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: July 6, 2022
Processing time: 294 Days and 20.4 Hours
Abstract
BACKGROUND

Systemic lupus erythematosus (SLE), characterized by the production of autoantibodies and widespread deposition of immune complexes, predominantly affects women of childbearing age. More than one-third of SLE patients present ocular manifestations. Choroidal disease is currently not completely understood, and its precise differentiation from central serous chorioretinopathy is rarely achieved. To date, no more than 60 patients with choroidal involvement have been reported.

CASE SUMMARY

A 37-year-old Chinese woman experienced decreased visual acuity bilaterally, accompanied by increasing periorbital swelling and severe conjunctival chemosis. Decreased breath sounds in both bases were detected via auscultation, as well as pitting edema in both ankles. SLE and lupus nephritis were diagnosed based on serositis, renal disorder, leukopenia and positive anti-Smith and anti-nuclear antibodies. Lupus choroidopathy was diagnosed based on ocular presentation and imaging. The patient was treated with systemic corticosteroids, spironolactone, hydroxychloroquine (HCQ), mycophenolate mofetil (MMF), and intravenous immunoglobulin. After 4 wk of hospitalization, the patient was discharged. Indocyanine green angiography showed no leakage from choroidal vessels, and ocular coherence tomography detected low amounts of subretinal fluid right before discharge. The patient was prescribed oral methylprednisolone, HCQ, and MMF. Two months after the first visit, ophthalmological examination revealed a visual acuity of 20/20 bilaterally, and SLE disease activity was well controlled; her symptoms disappeared completely.

CONCLUSION

Here we presented a case of lupus choroidopathy, successfully treated with systemic corticosteroids, and discussed previously reported cases, focusing on differential diagnosis with a central serous chorioretinopathy.

Keywords: Acute choroidal vasculitis; Corticosteroid; Hydroxychloroquine; Mycophenolate mofetil; Systemic lupus erythematosus; Case report

Core Tip: A 37-year-old Chinese woman with decreased visual acuity bilaterally, was diagnosed with systemic lupus erythematosus (SLE), lupus nephritis and lupus choroidopathy. Patient was successfully treated with systemic corticosteroids, spironolactone, hydroxychloroquine (HCQ), mycophenolate mofetil (MMF) and intravenous immunoglobulin during hospitalization and oral methylprednisolone, HCQ and MMF after discharge. Two months after the first visit, ophthalmological examination revealed a visual acuity of 20/20 bilaterally, and controlled SLE disease activity. Based on the case report and following literature review, lupus choroidopathy was discussed in the context of recurrence of underlying vasculitis; serous chorioretinopathy (CSC) was excluded and condition treated with immunosuppressive agents; spironolactone is discussed to be safe and helpful in both lupus choroidopathy and CSC.