Sarasi Jayaratne, DO, Gaurang Prabhu, MD, Ben Yoo, MD, Nina Swiacki, DO, Jennifer Ryal, MD; Eastern Virginia Medical School, Norfolk, VA
Introduction: Purtscher's-like Retinopathy is a rare disease entity seen in patients with systemic illnesses such as acute pancreatitis, vasculitis and HELLP Syndrome. It can present with reduced visual acuity or visual field loss. Visual prognosis is often guarded. We present the importance of evaluation of acute vision change in a young patient with alcohol induced pancreatitis.
Methods: 34 year-old Caucasian female with history of alcohol abuse presented with acute onset of nausea, vomiting, abdominal pain, and blurred vision over the past two days. Physical exam demonstrated equal, round, and reactive pupils, intact ocular movements, 20/100 visual acuity bilaterally and epigastric tenderness. She was found to have blood alcohol level of 0.31 g/dL, lipase elevated to 1,836 U/L and CT imaging consistent with acute pancreatitis. Given her new onset visual changes, CT and MRI of the head were performed and found to be unremarkable. Upon funduscopic exam and retinal scan, she was found to have classic findings associated with Purtscher’s retinopathy including; pseudo-cherry red spot (macular infarct) and Purtscher’s flecken (distinctly marked inner retinal whitening in posterior pole). Patient was diagnosed with bilateral Purtscher-like retinopathy related to her acute pancreatitis. Her visual prognosis was deemed poor due to infarct in the central macula. She received supportive care and has close outpatient ophthalmology follow up. Discussion: It is important to evaluate visual changes in patients presenting with acute pancreatitis. Purtscher retinopathy is an occlusive microvasculopathy. The diagnosis is clinical and may occur hours to days after the causal pathology with varying visual changes. Proposed diagnostic criteria generally includes either an associated illness or trauma with classic retinal findings on exam as seen in our patient. The prognosis for visual recovery is variable, whereas some patients experience spontaneous resolution while others have permanent vision loss. There are no well-established treatment guidelines available. High-dose steroids have been suggested in some case reports but there were no significant differences in visual acuity improvement between those given steroids versus those simply observed over time. This case highlights patients with acute pancreatitis who report acute vision changes should undergo formal funduscopic examination and educated on possibility of permanent visual loss and have continued close ophthalmology follow-up.
Figure 1. Funduscopic exam revealing pseudo cherry red spot and Purtscher’s flecken or distinctly marked inner retinal whitening in posterior pole and peripapillary regions