Multitarget microangiopathy in a young healthy man with COVID-19 disease: A case report

A 41?year?old man presented to the emergency department complaining of decrease of vision in his left eye. Initial examination was consistent with retrobulbar optic neuritis, and an intravenous drip of methylprednisolone was started. On the third day, the fundus examination revealed the appearance of multiple Purtscher?like cotton?wool spots in the posterior pole and nasally to the optic disc, slight retinal whitening around the fovea, and cherry?red spot. The patient reported flu?like symptoms, and he tested positive at PCR (polymerase chain reaction) test for 2019?nCoV (2019 novel coronavirus) infection. Assuming possible 2019?nCoV?related vascular damage, we prescribed low?molecular?weight heparin. The lesions were regressing at follow?up, and we registered a complete visual recovery

Retinopatía de Purtscher, como complicación inusual de la pancreatitis / Purtscher's Retinopathy, a Rare Complication of Pancreatitis

Introducción: La retinopatía de Purtscher o ceguera por pancreatitis es una complicación poco frecuente de la pancreatitis aguda. Objetivo: Presentar a una paciente que en el curso de una pancreatitis aguda desarrolla una retinopatía de Purtscher como complicación infrecuente. Caso clínico: Paciente de piel blanca, de sexo femenino de 52 años de edad, con antecedentes de salud, que ingresa en el servicio de cirugía con el diagnóstico de pancreatitis aguda litiásica, con elementos clínicos, humorales e imaginológicos de esta entidad. Durante su ingreso presenta pérdida brusca de la visión y es diagnosticada durante su exploración oftalmológica de una retinopatía Purtscher, con resolución del cuadro a los 3 meses, previo tratamiento con esteroides por vía oral. Conclusiones: La retinopatía de Purtscher es una complicación oftalmológica poco frecuente de la pancreatitis, por lo que en todo paciente con diagnóstico de pancreatitis y alteraciones visuales hay que sospechar esta entidad(AU)

Introduction: Purtscher's retinopathy or blindness due to pancreatitis is a rare complication of acute pancreatitis. Objective: To present the case of a patient who develops Purtscher's retinopathy as a rare complication during acute pancreatitis. Clinical case: 52-year-old female white-skinned patient without a previous history of medical conditions, admitted to the surgery service with a diagnosis of acute lithiasic pancreatitis, showing clinical, humoral and imaging elements characteristic of this entity. During her admission, she presented sudden vision loss. During her ophthalmological examination, she was diagnosed with Purtscher's retinopathy. The condition disappeared at three months, after treatment with oral steroids. Conclusions: Purtscher's retinopathy is a rare ophthalmological complication of pancreatitis, a reason why this entity should be suspected in all patients diagnosed with pancreatitis and visual disturbances(AU)

Electric shock induced Purtscher-like retinopathy

The most common ocular manifestation following electric shock injury is the development of cataract. Retinal manifestations can vary from development of macular holes to retinal detachments. Purtscher-like retinopathy following electrical injury has not been reported till date. We hereby present a case of a 19-year-old electrician who presented with grossly reduced vision in the right eye of 2 months following an electric shock. The fundus of the right eye showed macular ischemic degeneration, occluded vessels, cotton-wool spots, and hemorrhages. Optical coherence tomography angiography revealed presence of capillary drop-out in the para-foveal region, which was more pronounced in the deep capillary plexus. Electric shock injury can lead to a clinical picture simulating Purtscher's retinopathy. The electrical injury leads to a more extensive damage to the deep capillary plexus as compared with the superficial plexus.

Acute Pancreatitis with Purtscher's-like Retinopathy / 대한췌담도학회지

A 28-year-old man with a history of alcohol abuse was diagnosed with acute pancreatitis based on clinical symptoms, laboratory findings and computed tomography findings. On the second day of hospitalization, he complained of sudden visual disturbance. The ophthalmologic examination showed Purtscher's-like retinopathy. Two weeks after initial presentation, his vision was significantly improved along with epigastric pain. Retinal arteriolar occlusion by complement-mediated leukoembolization is the proposed pathogenic mechanism of Purtscher's-like retinopathy. Increased activity of proteases such as trypsin, associated with acute pancreatitis might be linked with the production of complement C5a. We report a rare case of Purtscher's-like retinopathy associated with acute pancreatitis.

Delayed Onset Purtscher's Retinopathy with Serous Retinal Detachment after Trauma in a Retinitis Pigmentosa

PURPOSE: To report a case of Purtscher's retinopathy accompanied by serous retinal detachment in a patient with retinitis pigmentosa (RP) who was referred to us for treatment of post-traumatic visual discomfort. CASE SUMMARY: A 36-year-old man with history of RP was referred to us with the chief complaint of bilateral visual discomfort after chest injury from a traffic accident. His corrected visual acuity was 0.3 and 0.6 in the right and left eyes, respectively. Fundus examination revealed findings characteristic of RP in both eyes, along with a lesion in the right eye, which was suspected to be a serous elevation of the macula, as well as suspected exudates near the optic nerves. Optical coherence tomography indicated serous retinal detachment in the right eye, and fluorescein angiography findings were characteristic of RP. Seven days later, the amount of cotton-wool exudate in the right eye had increased and was more distinct than at the initial examination, and retinal hemorrhage was observed. Based on the medical history and specific fundus findings, the patient was diagnosed with Purtscher's retinopathy. One month later, the serous retinal detachment in the right eye had improved, but the vision loss and total anopsia in the right eye persisted. CONCLUSIONS: The concomitant occurrence of RP and Purtscher's retinopathy is very rare. Moreover, the presence of accompanying serous retinal detachment and delayed onset of typical clinical symptoms are not present in typical Purtscher's retinopathy.

A Case of Purtscher's Retinopathy with Diffuse Serous Macular Detachment

PURPOSE: To report a case of Purtscher's retinopathy with diffuse serous macular detachment. CASE SUMMARY: A 63-year-old male patient presented to the hospital with decreased visual acuity. Three days prior to visiting the hospital, he had an blunt injury to the thoracic region caused by a steel beam, and his best corrected visual acuity was 20/50 in the right eye and 20/160 in the left eye. On slit lamp examination nothing unusual was observed in either eye, but fundus examinations showed retinal hemorrhages and a cotton wool spots on the posterior pole of the left eye and nothing unusual in the right eye. On fluorescein angiography, severe nonperfusion was observed at the posterior pole of the left eye. On optical coherence tomography, there was diffuse serous retinal detachment at the posterior pole and inferior retina of the left eye while mild subretinal fluid was observed at the posterior pole of the right eye. Under the suspicion of Purtscher's retinopathy in both eyes, oral prednisolone (40 mg) was prescribed and the dosage was gradually reduced. Six weeks after the treatment, best corrected visual acuity improved to 20/20 in the right eye, and 20/30 in the left eye. Additionally, subretinal fluid in the right eye completely disappeared. CONCLUSIONS: Purtscher's retinopathy is known as an ocular disease occurring after traumatic events. However, serous detachment of the macula has rarely been observed in Purtscher's retinopathy, and herein we report a case with diffuse serous macular detachment which responded to oral steroid treatment.

Spontaneously Resolved Purtscher's Retinopathy within 24 Hours: Case Report and OCT Review

PURPOSE: To report a case of unilateral Purtscher's retinopathy that spontaneously resolved within 24 hours. CASE SUMMARY: A 54-year-old man presented with decreased visual acuity in his left eye after a vehicle accident. When the accident occurred, his chest region was compressed by the safety belt. The case was diagnosed with Purtscher's retinopathy based on fundus examination, flourescein angiography (FAG) and optical coherent tomography (OCT). At presentation, the best corrected visual acuity (BCVA) was 0.3 in the affected eye. Tiny Purtscher-flecken and macular edema were observed but there was no sign of retinal hemorrhage. Immediately after the trauma, OCT detected abnormally increased hyperreflectivity in the nerve fiber layer and ganglion cell layer, severe cystoid edema and serous foveal detachment. Without any treatment, BCVA was improved to 1.0 within 12 hours. Recovery of visual acuity was followed by improvement of abnormal hyperreflectivity in the nerve fiber layer, cystoid macular edema and serous foveal detachment. CONCLUSIONS: The authors of the present study report a dramatically resolved unilateral Purtscher's retinopathy after blunt chest trauma.

Embolismo por polimetil-metacrilato posterior a inyección subcutánea en región glútea: a propósito de un caso / Polymethyl-methacrylate embolism after subcutaneous injection in gluteal region: report of a case

El polimetil-metacrilato es un polímero de alta resistencia al impacto, ampliamente utilizado en diferentes campos de la medicina, sin embargo, aún no está clara su indicación como relleno glúteo. A pesar de su aparente inocuidad, se han presentado complicaciones durante su uso como granulomas y nódulos palpables. Se han reportado casos de embolismo pulmonar por polimetil-metacrilato posterior a vertebroplastias. Sin embargo, no se encontró reporte bibliográfico de casos de embolismo pulmonar con su uso en procedimientos estéticos. Presentamos caso de paciente femenino de 31 años de edad, quien 4 horas luego de la inyección de 500 cm3 de polimetil-metacrilato en cada región glútea, presenta disnea en reposo de aparición súbita con tos seca y palpitaciones, disminución de agudeza visual y petequias generalizadas. Se diagnostica probable embolismo pulmonar por polimetil-metacrilato y retinopatía de Purtscher. Existe similitud clínica e imaginología del caso en estudio con embolismo por silicone, y las imágenes del fondo de ojo semejan la obstrucción de pequeñas arteriolas retinianas compatibles con este diagnóstico. Se sugieren nuevas investigaciones en el uso de polimetil-metacrilato como procedimiento estético en pro de la seguridad y en beneficio de los pacientes

Polymethyl-methacrylate is a high impact resistant polymer, widely used in different medicine fields, however its indication in buttock implants is still not clear. Even though its apparent innocuity, it has presented complications like granulomas and palpable nodules. There have been reported cases of pulmonary embolism caused by polimetil-metacrilato secondary to vertebroplasties. However, there have been no bibliographic cases of pulmonary embolism due to its use in aesthetic procedures. We present a case of a woman patient of 31 years old, who 4 hours after 500 cc injection of polymethyl- Methacrylate in each buttock, presents rest dyspnea with abrupt dry cough and palpitations, reduction in visual acuity and generalized petechiae. It is diagnosed probable pulmonary embolism by polimetil-metacrilato and Purtscher retinopathy. There is a clinical and imaginological similitude between this case and silicone embolism and the images of fondoscopy are similar to those of small retinian arteriole obstruction compatible with the diagnosis. Thereby, it is suggested new investigations in the use of polymethyl-methacrylate as esthetic procedure in favor of the patient’s security and benefit

A Case of Purtscher's Retinopathy Responsive to High-dose Steroid Therapy

PURPOSE: To report a case of high dose steroid-responsive Purtscher's retinopathy which was developed after operation for diaphragmatic laceration sustained in motorcycle accident. CASE SUMMARY: A 68-year-old man came to our hospital with complaining of decreased visual acuity in the right eye after diaphragmatic laceration operation. Best corrected visual acuity was 0.1 in the right eye. Anterior segment was nonspecific. However, afferent pupillary defect was observed. Superficial intraretinal hemorrhage, numerous cotton-wool spots, peripapillary hemorrhage, and macular edema were detected on fundus examination. Fluorescein angiography revealed capillary nonperfusion and fluorescein filling defect due to retinal hemorrhage in arteriovenous phase and fluorescein leakage from the macula and capillary nonperfusion area in the late venous phase. Accordingly, Purtscher's retinopathy was diagnosed and the patient was observed without specific treatment. After 2 weeks of observation, symptoms and fundus findings were not changed. High-dose steroid therapy was begun with injection of one gram of methylprednisone for three days, switched to oral prednisolone, and then slowly tapered in period of 3 weeks. 7 days after the treatment, visual acuity was improved to 0.2 in the right eye but afferent pupillary defect was still observed. Cotton-wool spots slightly decreased, peripapillary hemorrhage was absorbed but macular edema was remained. 14 days after the treatment, visual acuity greatly improved to 0.63 and afferent pupillary defect was not observed. Cotton-wool spots and macular edema were decreased but fluoroscein leakage from capillary nonperfusion area was remained. CONCLUSIONS: In the case of Purtscher's retinopathy, high-dose steroid therapy can be a useful management method for the improvement of visual acuity and other symptoms.

Purtscher's-lke Retinopathy in Patients with Systemic Hypertension

Since Purtscher's original discriptions similar clinical signs have been described following acute compressive neck or chest injuries, chest compression, val salva maneuvers, long bone fractures, acute pancreatitis and after childbirth. The appearance of Purtscher's retinopathy are believed to be due to ischemic episodes particularly in the end arterioles around the macula and disc. We experienced two cases of Purtscher's-like retinopathy in patients with systemic hypertension who had not any recent trauma history and reviewed the available literatures regarding this disease.

A Case of Purtscher's Retinopathy

A 46 year old man with unilateral Purtscher's retinopathy is described. On ophthalmic examination he had macular edema and multiple exudates and hemorrhages at the posterior pole of the left eye. Fluorescein angiography demonstrated impaired arteriolar flow, capillary non-per fusion, venous staining, and macular edema. The pathogenesis of Purtscher's retinopathy is unknown. Arterial and venous pressure elevation leading to vascular damage in the nerve fiber layer seems to be the most plausible explanation.