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5-Year Progressive Bull's Eye Maculopathy Despite Cessation of Hydroxychloroquine in Asian Systemic Lupus Erythematosus Lady

Author(s): Sunny Chi Lik Au

A 57-year-old systemic lupus erythematosus Chinese lady with maintenance hydroxychloroquine (HCQ) therapy of 200mg daily for 21years was weighed 61.5 kg-67.7 kg (mean 65.6 kg) throughout [1]. Regular ophthalmological tests in past decades first revealed subtle retinal pigment epithelium (RPE) changes, simulating early pericentral retinopathy pattern, on 2014’s fundus autofluorescence photos (Figure-1), and HCQ was immediately stopped [2,3]. Bull’s eye maculopathy was progressing inferiorly (Figure-2), to a combined parafoveal and pericentral retinopathy pattern (Figure-3), eventually generalized RPE atrophy (Figure-4) [3,4].

Safety HCQ dosage is 5mg/kg/day, yet retinal toxicity risk increases with consumption duration [1]. Maculopathy could progress after cessation of HCQ, given its long half-life of >1month [5].