A 23 year young female wi...

A 23 year young female, known Retroviral disease on TLD regimen, presented with mucocutaneous manifestations( ACLE, DLE), Neuropsychiatric symptoms( Psychosis, altered behavior) and diminution of vision. On evaluation she had ANA strong positive, Low complements, high titer anti Ds DNA positivity. On fundoscopy she had bilateral optic atrophy, Ghost sclerosed vessels and chorioretinal atrophic patches. Diagnosis of Purtscher’s retinopathy associated with SLE was considered. The points against to consider are- She had normal CD4 counts, viral load un detectable, there was associated chorioretinitis and any features suggestive of opportunistic infections in HIV causing this fundocopy features. Points considered favoring lupus are, She had hypocomplementemia, and anti ds DNA positivity and other associated clinical features like ACLE, DLE. She was treated with steroid, hydroxychloroquine and Rituximab 1 gm 2 doses. Panrerinal photo coagulation is scheduled.