Lupus Nephritis with Visual Field Defect Secondary to Hypertensive Retinopathy: A Case Report

    November 2017 in “ Journal of Surgical Academia ”
    Norshamsiah Md Din
    TLDR Visual field defects in lupus nephritis can be caused by hypertensive retinopathy, not glaucoma or medication toxicity.
    A 23-year-old woman presented with progressive painless blurring of vision and symptoms including malar rash, hair loss, and photosensitivity. She was diagnosed with grade 4 hypertensive retinopathy secondary to systemic lupus erythematosus (SLE), confirmed by positive ANA/dsDNA, low C3/C4, and renal biopsy showing lupus nephritis. Treatment included oral prednisolone, hydroxychloroquine, and cyclosporin A. Despite treatment, she developed non-progressive visual field defects due to cotton wool spots (CWS) indicating microinfarction of the retinal nerve fiber. This case highlighted that visual field defects from CWS in hypertensive retinopathy should not be mistaken for glaucoma or hydroxychloroquine toxicity.
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