Initial identification of antinuclear-antibody-negative systemic lupus erythematosus on ophthalmic examination: a case report, with a discussion of the ocular significance of anticardiolipin (antiphospholipid) antibodies.

A 21-year-old man presented with an acute life-threatening illness that was diagnosed and treated as thrombotic thrombocytopenic purpura. The patient survived and during his recovery noted that his central vision was markedly impaired in both eyes. An ophthalmologic examination showed inflammatory and ischemic changes in the retinal vasculature consistent with a diagnosis of systemic lupus erythematosus (SLE). Review of the patient's clinical and laboratory findings did in fact support a diagnosis of SLE that was negative for antinuclear antibody but positive for anticardiolipin antibody. The authors discuss the importance of an ophthalmic examination in patients with SLE-like syndromes and the significance of positivity for anticardiolipin antibody and other antiphospholipid antibodies in patients with thrombosis in the eye or elsewhere.