Title

PURTSCHER-LIKE RETINOPATHY: DESCRIPTION OF ONE LIKELY CASE

Summary

Female patient, 37 years old, previously healthy, admitted to the emergency unit on october 20th with complaints of cough, prostration, drowsiness, nuchalgia and fever, diagnosed with pneumonia. She evolved with significant respiratory effort and consolidation of both lung bases, was intubated and received ceftriaxone + azithromycin (from 20th to 22th october), ceftraixone + ampicilin (from 24th to 31th october). It was associated acyclovir for meningitis and encephalitis coverage, in addition to dexamethasone. Lumbar puncture was performed by neurology and showed opening pressure of 27cmH2O, 27 cells, proteins 212 mg/dL and glucose 86mg/dL. Skulls CT performed on october 24th and november 11th showed no brain abnormalities. Chest CT angiography (october 24th) showed no signs of central pulmonary thromboembolism. Evolved to extubation on october 27th. Completed use of venous acyclovir for 14 days on november 11th. She was discharged from hospital on November 11th, when she complained of low visual acuity. Ophthalmologic evaluation showed visual acuity of finger counts at 20cm in both eyes; mydriatic, isochoric and photoreactive pupils. In the fundus examination presented cotton-wool spots, flame-shaped retinal hemorrhages bilaterally, confined to the posterior pole, namely whithin the macula and immediately nasal to the optic disc; right optic disc swelling. On fluorescein angiography we observed the choroidal fluorescence masked by the cotton-wool spots and retinal hemorrhages and a late leakage from the retinal great vessels. Laboratory review for herpes family infectious tests (CMV, Epstein Barr, Herpes Simplex 1 and 2, Herpes Zoster), toxoplasmosis, HIV, syphilis were negative; The rheumatological tests also came negative, although we still await the result of the ANF. Our main diagnostic hypothesis at the moment is Purtscher-like retinophatie. Althought rare, the diagnosis is made on clinical grounds and supperted by intravenous fluorescein angiografy.

Area

CLINICAL CASE

Authors

BRUNELLE FRANCINO NUNES, Luís Felipe Silva Alves Carneiro, Renata Sousa Carneiro, Wilton Feitosa Araujo, Rafael Mourão Agostini, Luciana Schiavoni Vilela