Patient was diagnosed with inadequate coagulation secondary to Antiphospholipid Antibody syndrome (Hughes syndrome), an orbital apex lesion of the right optic nerve, microcystic anemia , thrombocytosis, and lupus nephritis
This case is very unique. The patient has several autoimmune disorders that correlate to one another. Initial referral from ER appeared to be for a retinal detachment or tear. Further lab work revealed underlying systemic inflammation due to autoimmune disease. The patient was non-compliant with prednisone dosage in the past and stated she had been tapering off the medication. She was no longer taking her daily aspirin for blood thinning. On top of these conditions the MRI also revealed a small mass that appeared to be impinging on the right optic nerve. Patient was referred to St. Joseph hospital in Phoenix where further imaging and testing was conducted. The small mass was determined to be a mucous retention cyst medial to the right orbital apex. The cyst was not compressing the optic nerve and was determined not to be the etiology of the amaurosis fugax.
Re-initiated Mycophenalate 250 mg, 6 capsules two times a day
Referred patient to Rheumatologist to co-manage
Referred patient to neuro-ophthalmology for further evaluation of mass
This case was very complex and illustrates the correlation between systemic autoimmune diseases and the eye. Amaurosis fugax is one of the most common ocular symptoms associated with Hughes syndrome. Eye care clinicians should be aware when to refer for further testing. Life-long oral anticoagulation is the treatment of choice to prevent future reoccurrences and thrombosis.
Lally L, Sammaritano L. Vasculitis in Antiphospholipid syndrome. Rheum Dis Clin N AM. 2015(41):109-123
Petri M. Review of Classification Criteria for Systemic Lupus Erythematosus. Rheum Dis Clin N AM. 2005(31):245-254
Boey M, Colaco CB, Gharavi AE, Elkon KB,Loizou, GR V Hughes. Thrombosis in systemic lupus erythematosus: striking association with the presence of circulating lupus anti-coagulant. British Medical Journal. 1983(287): 1021-1023
Atanasovva P. Antiphospholipid syndrome and Vascular Ischemic (Occlusive) Diseases: An Overview. Yonsei Med J. Dec 31, 2007; 48(6):901-926
Saxena R, Mahajan T, Mohan C. Lupus nephritis: current update. Arthritis Res Ther.2011; 13(5):240.