Retinal Detachment Following Janus Kinase Inhibitor Therapy in a Patient with Systemic Lupus Erythematosus: A Case Report

Background: Janus kinase (JAK) inhibitors are effective in multiple autoimmune and inflammatory conditions. While their general safety profile is well-characterized, ocular events remain rare and poorly defined. A variety of ocular manifestations have been reported following JAK inhibitors from pharmacovigilance data including retinal changes. Case Presentation: We report a 50-year-old Chinese female with longstanding systemic lupus erythematosus (SLE) and refractory lupus panniculitis. Following the failure of numerous immunosuppressive therapies and anifrolumab, the patient was initiated on upadacitinib (UPA). Ten days postinitiation, she developed sudden-onset floaters, flashes, and a “dark shadow” in her right eye. Ophthalmologic evaluation confirmed a peripheral right retinal detachment without maculopathy. UPA was promptly discontinued, and she received conservative management with close ophthalmological monitoring. Her visual acuity remained stable throughout the event. Conclusions: This case highlights a rare and potentially sight-threatening ocular event following UPA initiation in an SLE patient. Clinicians must maintain a high index of suspicion for ocular complications and educate patients on the prompt reporting of visual disturbances when initiating JAK inhibitor therapy.