DOI: 10.12890/2025_005854
Sudden bilateral vision loss in a young patient with systemic autoimmune disease and a normal brain MRI, which responded to steroid treatment
Authors
marcorguez16@gmail.com
Keywords
Bilateral vision loss, systemic lupus erythematosus, autoimmune optic neuropathy, corticosteroids, neuro-ophthalmologyAbstract
Background: Sudden bilateral visual loss is a rare but alarming manifestation, particularly in young patients with systemic autoimmune disorders.
Case report: We describe the case of a 26-year-old woman with systemic lupus erythematosus, juvenile idiopathic arthritis, and Sjögren’s syndrome, who presented with sudden bilateral vision loss following headache, vomiting, and diarrhoea. Ophthalmologic evaluation excluded hydroxychloroquine toxicity. Brain magnetic resonance imaging revealed no acute ischemic or demyelinating lesions. High-dose intravenous methylprednisolone was initiated, leading to near-complete recovery of vision.
Conclusion: Autoimmune optic neuropathy should be considered in young patients with sudden bilateral vision loss, even in the absence of neuroimaging abnormalities. Prompt recognition and empirical corticosteroid therapy may prevent irreversible disability.
References
- Sayeed SKJB, Khan AH, Moniruzzaman M, Mahmud R, Rahman MM. Systemic lupus erythematosus with acute ischemic optic neuropathy complicated with neuromyelitis optica: a case report. J Med Case Rep 2023;17:21. doi: 10.1186/s13256-022-03734-8
- Costa ACM, Dpf N, Júlio PR, Marchi-Silva R, De Aquino BM, de Oliveira Andrade S, et al. Neuropsychiatric manifestations in systemic lupus erythematosus and Sjogren’s disease. Autoimmun Rev 2025;24:103756. doi: 10.1016/j.autrev.2025.103756
- Man BL, Mok CC, Fu YP. Neuro-ophthalmologic manifestations of systemic lupus erythematosus: a systematic review. Int J Rheum Dis 2014;17:494-501. doi: 10.1111/1756-185X.12337
- Soelberg K, Skejoe HPB, Grauslund J, Smith TJ, Lillevang ST, Jarius S, et al. Magnetic resonance imaging findings at the first episode of acute optic neuritis. Mult Scler Relat Disord 2018;20:30-36. doi: 10.1016/j.msard.2017.12.018
- Galetta SL. A new classification for diagnosis of optic neuritis. Lancet Neurol 2022;21:1066-1068. doi: 10.1016/S1474-4422(22)00334-9
- Ayuso T, Aliseda D, Ajuria I, Zandío B, Mayor S, Navarro MC. Neuritis óptica inflamatoria. Anales del Sistema Sanitario de Navarra 2009;32:249–263. https://doi.org/10.23938/ASSN.0164
- Bendorius M, Po C, Muller S, Jeltsch-David H. From Systemic Inflammation to Neuroinflammation: The Case of Neurolupus. Int J Mol Sci 2018;19:3588. doi: 10.3390/ijms19113588
- Ahn GY, Kim D, Won S, Song ST, Jeong HJ, Sohn IW, et al. Prevalence, risk factors, and impact on mortality of neuropsychiatric lupus: a prospective, single-center study. Lupus 2018;27:1338-1347. doi: 10.1177/0961203318772021
- De Andrade FA, Guimarães Moreira Balbi G, Bortoloti de Azevedo LG, Provenzano Sá G, Vieira de Moraes Jr H, Mendes Klumb E, et al. Neuro-ophthalmological manifestations in systemic lupus erythematosus. Lupus 2017;26:522–528. doi: 10.1177/0961203316683265
- McGlasson S, Wiseman S, Wardlaw J, Dhaun N, Hunt DPJ. Neurological Disease in Lupus: Toward a Personalized Medicine Approach. Front Immunol 2018;9:1146. doi: 10.3389/fimmu.2018.01146
- Bennett JL. Optic Neuritis. Continuum (Minneap Minn) 2019;25:1236-1264. doi: 10.1212/CON.0000000000000768
- Gal RL, Vedula SS, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev 2015;2015:CD001430. doi: 10.1002/14651858.CD001430.pub4
