June 22, 2017
A 21-year-old Hispanic woman presented to the University of New Mexico with a 1-month history of worsening flashes of light and scotomas in her left superior field of vision.
Regarding her medical and ocular history, the patient had previously been diagnosed with a “generalized vasculitis.” When she was 14 years old, she developed joint pain in her wrists, ankles and knees. Within a week of the onset of the arthralgias, she also lost vision in the right eye and has since only seen bare light perception in that eye. She was followed by an outside ophthalmologist who told her he had seen “inflammation and a vitreous hemorrhage” in her right eye. She subsequently had a vitrectomy with no improvement in her vision. According to the patient, she had a complete systemic workup at that time that was unremarkable. Medical records provided by the patient indicated that her working diagnosis was “lupus retinal vasculitis.” However, the patient refuted this diagnosis, reporting that she had tested negative. She was followed closely by a rheumatologist who had prescribed her a high dose of methotrexate, which she was able to be weaned off within 2 years at age 16 given that she had not experienced any subsequent flares. Since that time, she had moved to Albuquerque, New Mexico, but had not re-established immediate care with a new rheumatologist.