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An instance of Chilblain lupus that is caused by an inherited modification of the individual's genome.
No HPO annotations are available for this condition.
Clinical information about RVCL-S is summarized from the following reports of individuals with molecularly confirmed RVCL-S: , , , , , , , , , , , , , , and . The numerators and denominators in this section are derived from the study by , which included 11 affected families and is the largest study to date on RVCL-S. RVCL-S is a small-vessel disease that systemically affects various highly vascularized organs. Affected individuals develop retinal vasculopathy and neurologic symptoms, in addition to other systemic manifestations including impaired liver and renal function. Clinical presentation is variable; onset is often between ages 35 and 50 years, with a mean age at clinical diagnosis of 42.9 years (SD ±8.3, range 25-61 years).
There are no consensus clinical diagnostic criteria for retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S).
RVCL-S should be suspected in individuals with the following findings .
Major features
Source: GeneReviews — "Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations"
No approved treatments are currently available for familial chilblain lupus. The disease remains an area of unmet medical need.
Evaluations Following Initial Diagnosis To establish the extent of disease and needs of an individual diagnosed with retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 4. Recommended Evaluations Following Initial Diagnosis in Individuals with RVCL-S
There are currently no consensus guidelines for monitoring individuals with RVCL-S. However, close monitoring is recommended. The frequency of monitoring depends on the manifestations and rate of disease progression . Table 6. Recommended Surveillance for Individuals with RVCL-S
No clinical trials have been registered for familial chilblain lupus.
7 publications have been identified in PubMed for familial chilblain lupus. Research spans Case Report / Case Series (43%), Basic Science / Preclinical (29%), and Review / Meta-Analysis (14%).
Han L (2026). [PMID: 41564501](https://pubmed.ncbi.nlm.nih.gov/41564501/). *Bioorganic & medicinal chemistry*. [Basic Science / Preclinical]
Hosseini SA (2026). [PMID: 31335009](https://pubmed.ncbi.nlm.nih.gov/31335009/). *Unknown Journal*. [Basic Science / Preclinical]
Hao W (2026). [PMID: 41939917](https://pubmed.ncbi.nlm.nih.gov/41939917/). *Front Immunol*. [Case Report / Case Series]
Velaoras AT (2026). [PMID: 42125077](https://pubmed.ncbi.nlm.nih.gov/42125077/). *JAAD Case Rep*. [Case Report / Case Series]
Burke OM (2025). [PMID: 40543672](https://pubmed.ncbi.nlm.nih.gov/40543672/). *Journal of the American Academy of Dermatology*. [Review / Meta-Analysis]
Data assembled from 4 of 12 sources · Last updated Sep 18, 2026, 7:14 PM UTC
Patient Advocacy Groups (PAGs) provide support, resources, and community for patients and caregivers.
European rare disease database
Genetic and Rare Diseases Info Center
Source: GeneReviews — "Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations"
Due to the systemic nature of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S), the differential diagnosis is quite broad. Following are differential diagnoses specifically for the characteristic and seen in RVCL-S. For other inherited disorders with phenotypic similarities see . Focal and/or Global Brain Dysfunction / MRI Brain Abnormalities Focal and/or global brain dysfunction and MRI brain abnormalities (intracerebral mass lesions and white matter abnormalities) seen in RVCL-S can be similar to intracranial neoplasm, multiple sclerosis, multi-infarct dementia, and central nervous system vasculitis. In these disorders other organs are usually not affected. Moreover, these conditions do not typically follow an autosomal dominant inheritance pattern. • In sarcoidosis and systemic lupus erythematosus (SLE) there can be focal and/or global brain dysfunction as well as involvement of multiple organs, as is seen in RVCL-S. • With sarcoidosis, however, there is frequent involvement of the lungs and skin. No lesions in the lungs have been described in individuals with RVCL-S and skin lesions are not frequently reported . Vascular Retinopathy Vascular retinopathy can occur as a long-term complication of diabetes mellitus and hypertension: • As the vascular retinopathy in RVCL-S is usually observed at a relatively young age (retinopathy has been found in the third decade of life) it is unlikely to be a complication of hypertension or diabetes mellitus, even in those with RVCL-S who have co-occurrence of hypertension or diabetes. • Vascular retinopathy can also be caused by systemic lupus erythematosus, sarcoidosis, and ophthalmologic infections (which are outside of the scope of this GeneReview). • In Susac syndrome, vascular retinopathy and encephalopathy are part of the symptomatology, as is hearing loss, but hearing loss is very rare in RVCL-S. The pattern of white matter lesions seen on MRI may also help to distinguish the two conditions. Table 3. Inherited Disorders to Consider in the Differential Diagnosis of RVCL-S
DifferentialDiagnosisDisorder | Gene(s) | MOI | Clinical Features of the Differential Diagnosis Disorder |
|---|---|---|---|
NOTCH3 | AD | Focal neurologic symptoms; Progressive cognitive decline; Migraine; Mood disturbances; Apathy; White matter lesions on brain imaging; Positive family history | Clinical involvement limited to the brain; The pattern of white matter lesions on brain imaging differs from that in RVCL-S. CARASAL |
CTSA | AD | Ischemic stroke; Progressive cognitive decline; Extended white matter lesions on brain imaging; Hypertension | Hemorrhagic strokes occur frequently in CARASAL. CARASIL |
HTRA1 | AR | Stepwise deterioration in brain functions; Progressive cognitive decline; Extended white matter les... | — |
Source: GeneReviews — "Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations"
System/Concern | Evaluation | Comment |
|---|---|---|
Eyes | Ophthalmologic evaluation | Assess for signs of retinopathy, macular edema, glaucoma. |
Cardiovascular | Blood pressure | Assess for hypertension. |
Renal | Renal function tests1 | Consider referral to nephrologist for those w/significant renal insufficiency /or hypertension. Hepatology |
Neurologic | Assess cognitive function. | Consider referral to neurologist /or a neuropsychological evaluation. Assess for signs symptoms of migraines. |
Endocrinologic | Thyroid function3 | Refer to endocrinologist, if clinically significant |
Hematologic | Complete blood count | To assess for anemia; consider referral to gastroenterologist for possible occult GI bleeding. |
Rheumatologic | Assess for signs symptoms of Raynaud phenomenon. | — |
Psychiatric | Assess for psychiatric symptoms.4 | Consider psychiatric consultation. |
Other | Consultation w/clinical geneticist /or genetic counselor | 1. Serum creatinine, BUN, and urinalysis (to include creatinine and protein content) 2. Aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase, gamma-glutamyltransferase (GGT) 3. TSH and free T4 4. It is crucial that unnecessary diagnostic tests not be undertaken. |
Treatment of Manifestations in Individuals with Retinal Vasculopathy with RVCL-S Manifestation/Concern | Treatment | Considerations/Other |
Visual impairment | Retinal laser therapy | Can prevent slow down progression of retinal involvement that causes visual impairment |
Macular edema | Bevacizumab | Elevated eye pressure / |
Glaucoma | Standard treatment | — |
Hypertension | Standard treatment | May prevent further damage to involved organs |
Renal insufficiency | Standard treatment of hypertension | Refer to nephrologist. Renal replacement therapy (incl transplantation) may be considered in severe cases for those w/end-stage renal disease. |
Liver function abnormalities | There is no treatment for liver function abnormalities. | Monitor to prevent complications associated w/liver fibrosis to exclude other causes.1 Cerebral vascular |
edema | Consider corticosteroid therapy.2 | May reduce cerebral vasogenic edema but does not appear to treat the underlying lesion |
Migraine | Standard treatment | — |
Seizure disorder | Standard treatment w/antiepileptic drugs | Refer to neurologist. |
Hypothyroidism | Thyroid replacement therapy | — |
Anemia | Standard treatment | Intravenous iron therapy ( in rare cases blood transfusion) may be necessary. |
Raynaud phenomenon | Standard treatment | — |
Psychiatric concerns | Standard treatment | Refer to psychiatrist or neuropsychologist. When not properly monitored, affected individuals are frequently given incorrect diagnoses and often receive advice to stop drinking alcohol or stop their medication, while this is not required. 2. |
Source: GeneReviews — "Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations"
Although there is no evidence, the authors would advise against intravenous tissue-type plasminogen activator (IV tPA) for acute ischemic stroke. There is to date no proof that the neurologic manifestations are caused by occluded large blood vessels (RVCL-S is a small vessel disease), and the risk of complications of such treatment (e.g., a secondary hemorrhage) is assumed to be higher in affected individuals.
Source: GeneReviews — "Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations"
Currently, a pilot study for treating RVCL-S with aclarubicin has been started. For details, see ClinicalTrials NCT02723448. Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions.
Source: GeneReviews — "Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations"
View trials for familial chilblain lupus
System/Concern
Evaluation |
|---|
Frequency (Minimum) |
|---|
Eyes | Ophthalmologic evaluation | Annually starting in 4th decade or as appropriate based on symptoms Cardiovascular |
Hepatology | Liver enzymes2 serum albumin | Annually starting in the 4th decade |
Neurologic | Assessment of cognition | Annually or as appropriate based on symptoms starting after diagnosis Psychiatric |
Source: GeneReviews — "Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic Manifestations"
Estimated prevalence: <1 in 1,000,000 (VERY_RARE).
Cho LK (2025). [PMID: 39892888](https://pubmed.ncbi.nlm.nih.gov/39892888/). *The Journal of rheumatology*. [Gene Therapy / Novel Therapeutics]