Purtscher-like retinopathy: Ocular findings in a young woman with chronic kidney disease

Abstract

Purpose: To report a case of Purtscher-like retinopathy treated with systemic steroids in a young woman with chronic kidney disease.

Observations: An 18-year-old female with a stage 3b chronic kidney disease presented with bilateral, sudden vision loss during an influenza-like syndrome. Best corrected visual acuity (BCVA) was 20/32 bilaterally and fundoscopic examination revealed cotton-wool spots, Purtscher flecken and intraretinal haemorrhages. Flourescein angiography showed areas of retinal ischemia with vascular leakage and optical coherence tomography showed cystoid macular oedema. The patient completed a short-course treatment with high-dose oral steroids. After 1 week, BCVA was 20/20 bilaterally. After 1 month, fundoscopy and imaging evaluation revealed complete resolution of the retinal injury. This favorable outcome remained stable throughout the 1-year follow-up.

Conclusions: AND IMPORTANCE: Purtscher-like retinopathy is a rare, sight-threatening retinal disorder. We described a case of retinal injury presumably related to chronic kidney disease and possibly triggered by an influenza-like syndrome, with a favorable visual recovery.

Keywords: Chronic kidney disease; Influenza-like syndrome; Purtscher-like retinopathy; Retinal microvasculopathy; Systemic steroids.

Fig. 1

Colour fundus photographs of both eyes at presentation showing several ill-defined cotton-wool spots (asterisks); multiple, discrete areas of retinal whitening compatible with Purtscher flecken (white arrows); minimal flame-shaped and dot-and-blot intraretinal haemorrhages (black arrows); and scarce areas of arteriolar narrowing. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Red-free fundus photographs of both eyes at presentation displaying multiple areas of retinal whitening (asterisks) and intraretinal haemorrhages (white arrows).

Fig. 3

Flourescein angiography of both eyes at presentation showing areas of peripapillary retinal ischemia (asterisks), choroidal hypofluorescence (yellow arrow) and late parafoveal leakage (white arrows) with normal peripheral perfusion. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Spectral-domain optical coherence tomography of the left eye at presentation (top) showing hyperreflective inner retinal layers with classic Purtscher flecken (black arrow), cystoid macular oedema and a subfoveal neurosensorial detachment with a focal disruption of the ellipsoid band. After 1 month (bottom) showing a complete resolution of macular oedema with recovery of foveal depression and preserved photoreceptor's layer.