Introduction: Neuropsychiatric manifestations can occur in up to two-thirds of patients with systemic lupus erythematosus (SLE). The presentations as well as the underlying immunopathogenic mechanisms can be heterogeneous and therefore have an enormous impact on therapeutic options.
Clinical picture: We describe 2 patients who presented similarly with acute onset binocular reversible visual loss. The first patient had anti-phospholipid syndrome and optic neuritis, while the second patient suffered from posterior reversible leukoencephalopathy syndrome.
Treatment: Patient one was treated with anti-coagulation and immunosuppression while the second patient required the withdrawal of immunosuppression and supportive therapy.
Outcome: Both patients responded favourably and had complete visual recovery.
Conclusions: Different management strategies have to be employed for similar presentations having different aetiologies, underscoring the need for constant clinical vigilance.