A 20-year-old African American woman initially presented with unilateral vision loss, fatigue, weight loss, and a malar rash. Her visual acuity was 20/20 OD and 20/25 OS. A funduscopic examination of the left eye revealed an unusual dendritic pattern of widespread perivascular infiltrates (Figure, A). The right eye was normal. An initial workup revealed an antinuclear antibody level of greater than 8.0 IU/mL (normal range, 0.0-0.9 IU/mL) and markedly elevated levels of Sjögren syndrome antigens A and B, anti-Smith, and anti-ribonucleoprotein antibodies. The results of anti–double-stranded DNA and antiphospholipid antibody testing were negative. The results of a renal biopsy were found to be consistent with class V lupus membranous glomerulopathy. She improved clinically by taking intravenous steroids (Figure, B) and remained quiescent while receiving a combination of oral prednisone and mycophenolate mofetil.
Warren CC, Gendy MG, Kim JE. Unilateral Perivascular Infiltrates in Lupus Retinopathy. JAMA Ophthalmol. 2015;133(6):e145367. doi:10.1001/jamaophthalmol.2014.5367