Abstract
Introduction: Systemic lupus erythematosus (SLE) is a disease with a high cost of treatment, which is directly related to the severity of SLE and, despite the international efforts in research, remains as an aggravation without completely defined etiology, but with risk factors and physiopathology increasingly elucidated. Episcleritis and scleritis are seen in SLE and may be the characteristic of the disease, and although uncommon, may be the initial findings and precede other manifestations, and their occurrence is usually indicative of active disease. Report: A 23-year-old female patient from her home admitted to the infirmary with a personal history of SLE for 6 years, but without treatment and with a complaint of sudden loss of vision. Prior to hospitalization, the patient presented with fever, headache, general malaise and intense ocular pain. Used oral anti-inflammatory for relief. It evolved with loss of vision, ocular pain and hyperemia with central ocular opacity noticed by relatives. Initiated treatment with prednisone and azathioprine, follow-up of rheumatology and ophthalmology. The main diagnostic hypothesis was necrotizing scleritis, a complication of SLE due to sudden visual loss. He had pulse therapy. Despite the clinical improvement, there was a decrease in visual function. During the hospitalization it evolved with other intercurrences. She was discharged, diagnosed with SLE and necrotizing scleritis and maintenance treatment. Conclusion: Although scleral disease is rare, necrotizing anterior scleritis is extremely severe, as it may culminate in definitive visual loss. Efforts should be made for a rapid and correct diagnosis of this disease.