Atypical Presentation of Vitreous Inflammation in a Patient With Hypertensive Retinopathy

Abstract

Purpose: To describe an atypical presentation of vitreous inflammation in a patient with malignant hypertension. Methods: A case was evaluated. Results: A patient presenting with a hypertensive emergency was found to have decreased vision in the setting of severe optic nerve head edema, extensive hard exudates, cotton-wool spots, and Elschnig spots in both eyes secondary to malignant hypertension as well as vitreous cells bilaterally. He was admitted to the pediatric intensive care unit for intravenous medications and observation. Conclusions: This case adds to the growing body of evidence suggesting that hypertensive urgency may be accompanied by inflammation.

Keywords: Elschnig; Siegrist; choroidopathy; hypertensive retinopathy; vitreous inflammation.

Figure 1.

Twenty-one days after presentation, FA photographs of the patient’s right eye and left eye sequenced at 1 minute, 4 minutes, and 12 minutes show normal right-sided choroidal filling with a diffusely dilated disc and a capillary bed with moderate leakage throughout the peripapillary area (A, C, and E). (B, D, and F) Left-sided imaging shows a dilated disc capillary bed with increased disc leakage over time. Abbreviation: FA, fluorescein angiography.

Figure 2.

Twenty-one days after presentation, a dilated funduscopic examination of the right eye (A and C) and the left eye (B and D) shows bilateral optic nerve head edema, whitened vessels, marked retinal exudates, and subretinal fluid. (E and F) Fluorescein angiography shows leakage of fluid.

Figure 3.

One hundred forty-six days after initial presentation, a dilated funduscopic examination of the right eye (A and C) and the left eye (B and D) shows numerous, widespread pigmented Elschnig spots; several sclerotic long-segment choroidal vessels are present in both eyes. The optic nerves were mildly swollen and somewhat pale in both eyes. Hard exudates remain in the macula in both eyes. (E and F) Optical coherence tomographic imaging of the right eye and left eye with ganglion cell segmentation shows decreased overall thickness of the ganglion cell complex, with an average measurement of 49 µm and 78 µm, respectively.