Combined retinal vascular occlusion and optic neuritis revealing systemic lupus erythematosus: A case report

Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disorder that rarely presents with catastrophic ocular ischemia as its primary manifestation. We report an aggressive onset of SLE in a 45-year-old female with Tetralogy of Fallot, presenting with sudden profound painful vision loss in the right eye (perception of light), generalized weakness, and inability to bear weight on lower limbs (flaccid quadriparesis). Ophthalmic evaluation revealed combined central retinal artery and vein occlusion, confirmed by FFA. She also had fever and delirium. Systemic workup confirmed SLE. She was started on intravenous steroids and oral anticoagulants, leading to progressive systemic improvement. This case underscores the rarity of combined neuro-ophthalmic ischemia and motor weakness as an initial presentation of SLE, necessitating urgent multisystem intervention.