Purtscher-like retinopathy - a rare complication of acute pancreatitis

Czech version

Authors: B. Krahulec ¹; J. Štefaničková ²; S. Hlinšťáková ¹; E. Hirnerová ¹; V. Kosmálová ¹; J. Hasa ²; K. Peško ²; P. Strmeň ²; A. Dukát ¹
Authors‘ workplace: II. interná klinika LF UK a FNsP Bratislava, Slovenská republika, prednosta prof. MUDr. Andrej Dukát, CSc., FESC ¹; I. oftalmologická klinika LF UK a FNsP Bratislava, Slovenská republika, prednosta prof. MUDr. Peter Strmeň, CSc. ²
Published in: Vnitř Lék 2008; 54(3): 276-281
Category: Case Reports

Práca bola prednesená na 4. bilaterálnom slovensko-českom oftalmologickom sympóziu s medzinárodnou účasťou v Banskej Bystrici v dňoch 27.–29. 9. 2007

Overview

The article reports the case of a 27-year old woman hospitalised in the internal medicine ward for acute pancreatitis after eating fat food and drinking alcohol. In addition to acute pancreatitis, the patient complained of vision problems. The ophthalmologist detected bilateral occurrence of large whitish nidi located primarily around the optic disc, intraretinal hemorrhage and a massive retinal oedema in the central field and diagnosed Purtscher-like retinopathy. After a month of treatment of acute pancreatitis, the clinical picture improved, the patient's vision sharpness improved and the laboratory parametres returned to normal. The finding on the ocular fundus also improved. Even though similar cases are rare, more patients with acute pancreatitis should be checked for eventual vision disorders. Ocular fundus examination should be included in the set of tests performed for acute pancreatitis, similarly to the practice in arterial hypertension or diabetes mellitus patients.

Key words:
Purtscher-like retinopathy – acute pancreatitis

Sources

1. Chaum E. Retinopathy, Purtscher. http://www.emedicine.com/oph/topic419. htm, 2007.

2. Inkeles DM, Walsh JB. Retinal fat emboli as a sequela to acute pancreatitis. Am J Ophthalmol 1975; 80: 935–938.

3. Fumex L, Boizard Y, Burillon C et al. Purtscher retinopathy in acute alcoholic pancreatitis. A case report. J Fran d’Ophthalmol 2004; 27: 927–931.

4. Fauci AS, Braunwald E, Isselbacher KJ et al. Harrison’s principles of internal medicine. McGraw-Hill: New York 1998.

5. Vavrečka A Choroby podžalúdkovej žlazy. In: Jurgoš Ľ. et al. Gastroenterológia. Bratislava: Veda 2006, 529–579.

6. Weber J, Beck R, Franke A. Retinopathic visual loss in hemorrhagic necrotizing pancreatitis. Zentralbl Chir 1989; 114: 1466–1470.

7. Steel JR, Cockroft JR, Ritter JM. Blind drunk: alcoholic pancreatitis and loss of vision. Postgrad Med J 1993; 69: 151–152.

8. Clayton RLC, Leandro MAP, Flavio MCM at el. Purtscher-like retinoapthy associated with acute pancreatitis. Sao Paulo Med J 2005; 123: 289–291.

9. Devonport H, Oworu O, Mohla A et al. Purtscher’s like retinopathy as the presenting feature of acute alcoholic pancreatitis. Eye 2006; 20: 255–257.

10. Kincaid MC, Green WR, Knox DL et al. A clinicopathological case report of retinopathy of pancreatitis. Br J Ophthalmol 1982; 66: 219–226.

11. López-Tizón E, Reinoso-Montalvo C, Mencía-Gutiérrez E at al. Acute pancreatitis presenting as sudden blindness. Arch Soc Esp Oftalmol 2006; 81: 161–163.

12. Jacob HS, Goldstein IM, Shapiro I. Sudden blindness in acute pancreatitis. Possible role of complement-induced retinal leukoambolization. Arch Intern Med 1981; 141: 134–136.

13. Sanders RJ, Brown GC, Brown A et al. Purtscher’s retinopathy preceding acute pancreatitis. Ann Ophthalmol 1992; 24: 19–21.

14. Sharma AG, Kazim NA, Eliott D et al. Purtscher’s retinopathy that occured 6 months before acute pancreatitis. Am J Ophthalmol 2006; 141: 205–207.

15. Campo SMA, Gasparri V, Catarinelli G et al. Acute pancreatitis with Purscher’s retinopathy: case report and review of the literature. Dig Liver Dis 2000; 32: 729–732.

16. Flores MSD, Rodriguez IN, Bernal IL et al. Retinopathy as a systemic complication of acute pancreatitis. Am J Gastroenterol 1995; 90: 321–324.

17. Núnez L, Cubiella J, Moreno C et al. Purtscher’s retinopathy: a rare complication of acute non-alcoholic pancreatitis. Gastroenterol Hepatol 2003; 26: 541–544.

18. Hollo G, Tarjanyi M, Varga M et al. Retinopathy of pancreatitis indicates multiple-organ failure and poor prognosis in severe acute pancreatitis. Acta Ophthalmol 1994; 72: 114–117.

19. Bui SK, O’Brien JM, Cunningham ET. Purtscher retinopathy following drug-induced pancreatitis in an HIV-positive patient. Retina 2001; 21: 542–545.

20. Fabandeh H, Rosenfeld PJ, Alexandrakis G et al. Purtscher-like retinopathy associated with pancreatic adenocarcinoma. Am J Ophthalmol 1999; 128: 650–655.

21. Zwolinska D, Medynska A, Galar A. Purtscher-like retinopathy in nephrotic syndrome associated with mild chronic renal failure. Pediatr Nephrol 2000; 15: 82–84.

22. Chandra P, Azad R, Pal N et al. Valsalva and Purtscher’s retinopathy with optic neuropathy in compressive thoracic injury. Eye 2005; 19: 914–933.

23. Shah GK, Penne R, Grand MG. Purtscher’s retinopathy secondary to airbag injury. Retina 2001; 21: 68–69. 24. Roncone DP. Purtscher’s retinopathy. Optometry 2002; 73: 166–172.

25. Kocak N, Kaynak S, Kaynak T et al. Unilateral Purtscher-like retinopathy after weight-lifting. Eur J Ophthalmol 2003; 13: 395–397.

26. Ong T, Nolan W, Jagger J. Purtscherlike retinopathy as an initial presentation of thrombotic thrombocytopenic purpura: a case report. Eye 2005; 19: 359–361.

27. Schwartz SG, McPherson AR, Mieler WF et al. Bilateral combined occlusion of the central retinal artery and vein secondary to thrombotic thrombocytopenic purpura. Arch Ophthalmol 2000; 118: 1304–1305.

28. Patel MR, Bains AK, O’Hara JP et al. Purtscher retinopathy as the initial sign of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome. Arch Ophthalmol 2001; 119: 1388–1389.

29. Cooper BA, Shah GK, Grand MG. Purtscher’s-like retinopathy in a patient with systemic lupus erythematosus. Opthalm Surg Laser Imag 2004; 35: 438–439.

30. Stewart MW, Brazis PW, Guier CP et al. Purtscher-like retinopathy in a patient with HELLP syndrome. Am J Ophthalmol 2007; 143: 886–887.

31. Myers JP, DiBisceglie AM, Mann ES. Cryoglobulinemia associated with Purtscher- like retinopathy. Am J Ophthalmol 2001; 131: 802–804.

32. Meyer CH, Callizo J, Schmidt JC et al. Functional and anatomical findings in acute Purtscher’s retinopathy. Ophthamol 2006; 220: 343–346.

33. Agraval A, McKibbin MA. Purtscher’s and Purtscher-like retinopathies: a review. Survey Ophthalmol 2006; 51: 129–136.

34. Buckley SA, James B. Purtscher’s retinopathy. Postgrad Med 1996; 12: 409–412.

35. Beckingsale AB, Rosenthal AR. Early fundus flourescein angiographic findings and sequelae in traumatic retinopathy: case report. Br J Ophthalmol 1983; 67: 119–123.