When Blurry Vision Clouds the Bigger Picture

A 14-year-old adolescent presented with a 12-month history of joint pain, intermittent blurry vision, and severe bifrontal headaches. Symptoms worsened over three weeks despite ibuprofen use, leading to empirical treatment for Lyme disease, which proved ineffective. The patient also experienced eyelid swelling, pleuritic chest pain, fatigue, low-grade fevers, and unintentional weight loss.

Further evaluation revealed pancytopenia, nephritic syndrome, proteinuria, hematuria, and elevated autoantibodies, including ANA, anti-dsDNA, anti-Smith, and anti-RNP. MRI confirmed severe papilledema and intracranial hypertension. The diagnosis of childhood-onset systemic lupus erythematosus (SLE) was established, with lupus nephritis and neuropsychiatric involvement.Treatment included intravenous methylprednisolone, cyclophosphamide, and rituximab, followed by mycophenolate mofetil for disease maintenance. Within one week, symptoms improved, including headache resolution and reduced ocular inflammation. At the three-month follow-up, intracranial pressure had normalized, and kidney function had stabilized. The case underscores the severe presentations of childhood-onset SLE, emphasizing early diagnosis and aggressive immunosuppressive therapy to prevent long-term complications.

A 14-year-old adolescent presented with a 12-month history of joint pain, intermittent blurry vision, and severe bifrontal headaches. Symptoms worsened over three weeks despite ibuprofen use, leading to empirical treatment for Lyme disease, which proved ineffective. The patient also experienced eyelid swelling, pleuritic chest pain, fatigue, low-grade fevers, and unintentional weight loss.

Further evaluation revealed pancytopenia, nephritic syndrome, proteinuria, hematuria, and elevated autoantibodies, including ANA, anti-dsDNA, anti-Smith, and anti-RNP. MRI confirmed severe papilledema and intracranial hypertension. The diagnosis of childhood-onset systemic lupus erythematosus (SLE) was established, with lupus nephritis and neuropsychiatric involvement.Treatment included intravenous methylprednisolone, cyclophosphamide, and rituximab, followed by mycophenolate mofetil for disease maintenance. Within one week, symptoms improved, including headache resolution and reduced ocular inflammation. At the three-month follow-up, intracranial pressure had normalized, and kidney function had stabilized. The case underscores the severe presentations of childhood-onset SLE, emphasizing early diagnosis and aggressive immunosuppressive therapy to prevent long-term complications.