ALTHOUGH ocular lesions are known to occur in acute systemic lupus erythematosus, the only report in Great Britain of the histological examinationi of the eyes in this disease appears to be that of Semon and Wolff (1933), who found only mild choroiditis and subretinal exudation. The purpose of this paper is to record the clinical, ophthalmoscopic, and pathological findings in two cases which terminated fatally.
Case ReportsCase 1, a married woman, aged 24, a diabetic of 8 years' standing, attended the Dermatological Department of the Bristol General Hospital in June, 1949, complaining of an irritating red rash of 2 months' duration on her forehead, face, and ears.Examination.-A scaling erythematous rash was present on the forehead extending down to the bridge of the nose and on to both cheeks and both ears. Her temperature was 99-2°F. General physical examination revealed only a systolic murmur heard in the mitral area. She was admitted under the care of Dr Course and Therapy.-She was treated by rest in bed, bland local applications, and an increase in insulin. On discharge 5 weeks later, the rash was much paler and less extensive. She then attended as an out-patient, but was readmitted in September with a diagnosis of acute systemic lupus erythematosus. The rash now covered the whole of the face, trunk, and limbs, but was more severe and darker red on the face, ears, and dorsa of the hands and feet. The extensor muscles were tender on pressure, and there was generalized stiffness, pain, and muscular weakness. A muscle biopsy showed only roundcell and plasma-cell interstitial infiltration without loss of muscle striation, so that dermatomyositis was ruled out. A general physical examination revealed no other abnormalities. The diabetes was controlled.From the time of readmission, her condition gradually deteriorated. Irregular pyrexia (990-1010 F.) persisted, in spite of aspirin and a 5-day course of procaine penicillin, 300,000 units morning and evening.By December a severe diffuse alopoecia of the scalp was present. A normochromic anaemia was treated by a transfusion of 1 pints of blood.
