Bilateral neuroretinitis and membranous lupus nephritis: two infrequent manifestations in juvenile lupus

Abstract

Objetive: To describe a case of bilateral neuroretinitis (NR) and membranous lupus nephritis (LN) in recent onset juvenile lupus.

Clinical case: 15-year-old female patient, previously healthy, referred to our center for presenting abdominal pain, vomiting, diarrhea, erythema in butterfly wings, erythematous lesions on the arms, palpebral and lower limb edema, arthralgia, morning stiffness and bilateral blurred vision. Laboratory and imaging studies were performed that together with the clinic, allowed the diagnosis of nephrotic syndrome secondary to systemic lupus erythematosus (SLE). Ophthalmology examination revealed a visual acuity of 8/10 in both eyes and bilateral disc edema with partial macular star more evident in the left eye, findings compatible with bilateral NR. A renal biopsy was indicated, which established the diagnosis of membranous LN. Immunosuppressive treatment was started, obtaining gradual clinical improvement.

Conclusion: Although SLE with membranous LN and NR is a very infrequent association, when  faced with a patient with bilateral NR, we must consider SLE within the differential diagnoses. As well as we must include the complete ophthalmological examination in the initial evaluations of all patients with SLE to determine the real prevalence of ocular manifestations in this pathology.