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.

Amaurosis súbita asociada a meningoencefalitis criptocócica / Sudden blindness associated to cryptoccocal meningitis

Antecedentes: La criptococosis es una de las infecciones intercurrentes que afecta a los pacientes con SIDA y la meningoencefalitis por criptococos es de las complicaciones neurológicas más grave, que puede incluir compromiso visual permanente. Propósito: Aunque el compromiso de la visión es infrecuente, es interesante definir los modos de esta patología visual, que está directamente relacionada con la infección. Paciente y Método: Se describe un paciente de 43 años portador de un SIDA, que desarrolla una meningoencefalitis recurrente por criptococo y que en su tercer episodio, iniciado con cefalea y fiebre se instala una amaurosis aguda. Tenía un LCR con 3,35 mg/dl de proteínas, glucosa 0,13 mg/dl y 225 leucocitos. La RM mostró leptomeningitis difusa, ventriculitis e inflamación del nervio óptico. Tratado con anfotericina, el paciente recuperó su condición basal, aunque logró sólo una leve mejoría de la visión. Conclusiones: Este paciente configura la forma más infrecuente de ceguera vinculada a criptococosis, como es la pérdida aguda de la visión, vinculada a una aracnoiditis optoquiasmática y a una neuropatía óptica, vinculada a compromiso vascular.

Background: Cryptococcal disease is one of the most common opportunistic infection in AIDS patients and cryptoccocal meningitis is the most serious neurological form. Aim: Although the affection of the visual pathway is rare, it is interesting to analyze the types of visual involvement related to cryptococcal infection, which prognosis is almost irreversible. Patient and Method: we present a 43-year-old patient with AIDS and remitting cryptoccocal meningoencephalitis who developed an acute and bilateral blindness during the third episode. The cerebrospinal fluid analysis showed proteins 3,35 gr/L, glucose 0,13 gr/L and 225 cells. MR showed difuse leptomeningitis, ventriculitis and optic neuritis. After treatment with anphotericin, the patient recovered to basal conditions, although only mild visual improvement was achieved. Conclusion: sudden blindness and MR findings defined a bilateral optical neuritis and an optoquiasmatic arachnoiditis, which is the most infrequent form of cyptoccoccus related blindness.