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

Corresponding Author:
Sunny Chi Lik Au
Department of Ophthalmology
Tung Wah Eastern Hospital, Hong Kong
E-mail:
[email protected]

Abstract

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].

Introduction

A 57-year-old systemic lupus erythematosus Chinese lady with maintenance hydroxychloroquine (HCQ) therapy of 200 mg daily for 21 years 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 combined parafoveal and pericentral retinopathy pattern (Figure 3), eventually generalized RPE atrophy (Figure 4) [3,4].

ijocs-autofluorescence

Figure 1: Fundus autofluorescence photos of both eyes in 2014.

ijocs-maculopathy

Figure 2: Fundus autofluorescence photos of both eyes in 2016 showing progression of the Bull’s eye maculopathy from hydroxychloroquine retinal toxicity despite cessation of systemic treatment in 2014.

ijocs-hydroxychloroquine

Figure 3: Fundus autofluorescence photos of both eyes in 2017 showing progression of the Bull’s eye maculopathy from hydroxychloroquine retinal toxicity despite cessation of systemic treatment in 2014.

ijocs-toxicity

Figure 4: Fundus autofluorescence photos of both eyes in 2019 showing progression of the Bull’s eye maculopathy from hydroxychloroquine retinal toxicity despite cessation of systemic treatment in 2014.

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

References

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