Systemic Lupus Erythematosus and Third Nerve Palsy: Unusual Presentation and Review of the Literature

ABSTRACT

We report the case of a young female with pyrexia of unknown origin, cutaneous macules and an incomplete third cranial nerve palsy, that led to the diagnosis of systemic lupus erythematosus (SLE) with neurological manifestations. Her visual acuity was normal. Fundus examination showed cotton wool spots in both eyes. Neuroimaging was also normal. Systemic work up revealed pancytopaenia, hypocomplementaemia, and the presence of multiple autoantibodies including anti-double stranded deoxyribonucleic acid and lupus anticoagulant. She was effectively treated with intravenous pulsed corticosteroid therapy, cyclophosphamide, and oral hydroxychloroquine. This case highlights the uncommon involvement of cranial nerve mononeuropathy in SLE, the importance of systemic examination and autoimmune workup in young patients with such a presentation.

KEYWORDS:

• Isolated
• incomplete third cranial nerve palsy
• systemic lupus erythematosus
• pyrexia of unknown origin
• pancytopaenia

Acknowledgments

We thank our diagnostic and photographic teams of L V Prasad Eye Institute, GMR Varalakshmi Campus, for their support in patient management and documentation of the clinical pictures and investigations.

Declaration of interest statement

None of the authors have any commercial interests related to materials or techniques described to disclose.

Additional information

Funding

Hyderabad Eye Research Foundation (HERF), Hyderabad, Telangana, India.