Advanced hydroxychloroquine maculopathy against medical advice

Abstract

A 67-year-old female with systemic lupus erythematosus returned to her ophthalmologist for evaluation of nyctalopia and decreased peripheral vision in both eyes for several months. On her initial presentation two years prior, she was noted to have signs of advanced hydroxychloroquine toxicity on fundus examination, fundus autofluorescence, and optical coherence tomography. Despite counseling by multiple physicians, she refused to discontinue the medication and did not return for her regularly scheduled eye examinations for the next 24 months. Her current presentation details and documents (with several imaging modalities) the progression of advanced hydroxychloroquine maculopathy while continuing treatment. With some regularity, Ophthalmologists are faced with the difficult clinical dilemma to help determine if a patient should discontinue HCQ therapy. This case emphasizes why detecting clinical toxicity and discontinuing therapy is crucial for the safe usage of this frequently prescribed medication.