Purtscher-like retinopathy in acute alcoholic pancreatitis

Abstract

A 23-year-old man with a history of alcoholism presented with vomiting, fever, and sharp epigastric pain radiating to the back and flanks. He was diagnosed as a case of acute alcoholic pancreatitis on the basis of clinical findings and investigations. On the next day of presentation, he developed sudden bilateral visual loss. His best-corrected visual acuity was finger counting at one-foot distance in both eyes. He had diffuse whitening in the circumpapillary area, haloes around the retinal vessels (Purtscher flecken) and intra-retinal hemorrhages on ophthalmoscopic examination. Optical coherence tomography revealed bilateral macular edema. These findings were characteristic of Purtscher-like retinopathy. The patient showed systemic and visual improvement at 8 weeks follow-up after receiving the conventional treatment for acute alcoholic pancreatitis. This case emphasizes the importance of fundus examination by an ophthalmologist in the diagnosis of this rare under-diagnosed entity.

Keywords: Cotton-wool spots; Purtscher flecken; optical coherence tomography.

Figure 1

Contrast-enhanced computerized tomography abdomen axial scan showing collection of fluid around pancreas along with inflammation (green arrows)

Figure 2

(a and b) Fundus photographs showing Purtscher flecken (arrow) and intraretinal hemorrhages involving the posterior poles of both eyes

Figure 3

(a and b) Optical coherence tomography showing bilateral inner retinal and macular edema

Figure 4

(a and b) Fundus photographs showing resolving retinal whitening at 8-week follow-up visit

Figure 5

(a and b) Optical coherence tomography at 8-week follow-up showing diminished retinal edema