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Case Reports
. 2024 Aug 12:12:2050313X241269565.
doi: 10.1177/2050313X241269565. eCollection 2024.

Purtscher-like retinopathy: Case report of a rare complication of acute on chronic pancreatitis

Ginimal Bandaralage Kavinda Deshapriya Bandara  1 , Duminda Subasinghe  1   2 , Chanika Gamage  3 , Pradeepa Siriwardene  3 , Nilesh Fernandopulle  1   2
Affiliations
Case Reports

Purtscher-like retinopathy: Case report of a rare complication of acute on chronic pancreatitis

Ginimal Bandaralage Kavinda Deshapriya Bandara et al. SAGE Open Med Case Rep. .

Abstract

Purtscher's retinopathy is an occlusive micro-vasculopathy causing sudden onset visual loss in trauma. Similar retinal appearance is observed as a rare complication of acute pancreatitis which is identified as Purtscher-like retinopathy (PulR). We report the case of a 15-year-old girl diagnosed to have acute on chronic pancreatitis who noticed a sudden onset loss of vision in the left eye and was found to have significantly diminished visual acuity. A dilated fundoscopic examination demonstrated pathognomonic Purtscher flecken, multiple retinal haemorrhages, cotton wool spots and macular oedema. A clinical diagnosis of PulR was made in the setting of acute on chronic pancreatitis. Optical coherence tomography was used to support the diagnosis and to monitor response to therapy. Given the variable prognosis with no evidence-based therapies available, she had a subjective improvement in visual acuity with administration of intravitreal steroids and observation with management of the acute episode of pancreatitis. Knowledge and awareness of this rare condition will enable its early detection and the search for newer therapies.

Keywords: Purtscher-like; pancreatitis; retinopathy.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Typical fundoscopic appearance of Purtscher’s retinopathy showing pathognomonic Purtscher flecken, cotton wool spots and retinal haemorrhages. The black arrow denotes Purtscher flecken found between retinal vessels and well demarcated than cotton wool spots.
Figure 2.
Figure 2.
Fundal photo after 1 week showing disappearance of Purstscher flecken. Retinal haemorrhages and cotton wool spots are still seen.
Figure 3.
Figure 3.
OCT after 1 week showing improved macular oedema and disrupted IS/OS junction. IS, inner segment; OCT, optical coherence tomography; OS, outer segment.
Figure 4.
Figure 4.
Fundal photo after 3 weeks showing improvement in retinal haemorrhages and cotton wool spots.
Figure 5.
Figure 5.
OCT after 3 weeks showing settled macular oedema. But poor prognostic features like disrupted IS/OS junction and macular atrophy are evident. IS, inner segment; OCT, optical coherence tomography; OS, outer segment.
See this image and copyright information in PMC

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