Purtscher's-like retinopathy in acute alcoholic pancreatitis

• Published in: BMJ case reports 2016-09, Vol.2016, p.bcr2016215485, Article bcr2016215485
• Main Authors: Subudhi, Praveen, Kanungo, Sanghamitra, Rao Subudhi, Nageswar
• Format: Article
• Language: English
• Subjects: Acute Disease; Adrenal Cortex Hormones - therapeutic use; Adult; Asia; Humans; Indian Sub-Continent; Male; Pancreatitis, Alcoholic - complications; Rare Disease; Retinal Diseases - drug therapy; Retinal Diseases - etiology; Vision Disorders - etiology; Visual Acuity
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-215485

A 28-year-old man presented with a sudden onset of visual loss in both eyes (OU). He had a known history of acute pancreatitis and hepatitis following alcohol abuse. Examination of the anterior segment of the eye revealed non-sustained pupillary light reaction. The fundus showed typical Purtscher's flecken over the posterior pole with multiple cotton wool spots and retinal superficial haemorrhages in OU. Fundus fluorescein angiogram revealed abnormal hypofluorescence in both the posterior poles. Optical coherence tomography (OCT) for Purtscher's flecken showed abnormal retinal thickening with hyper-reflective areas in the inner neurosensory layers. The patient responded favourably to high-dose corticosteroid therapy (1.5 mg/kilogram per body weight) with a tapering dose. There was a mild reduction of the ischaemic areas with a corresponding improvement in visual acuity. This case has been presented owing to its rarity and under-reporting. Treatment with corticosteroids yielded favourable results.