Title

BILATERAL RETINA SEROUS DETACHMENT

Summary

A 21-year-old female patient came to the emergency department complaining of sudden and painless low vision in both eyes for one day. An extensive anamnesis was performed, the patient denied headache, viral prodromes and reported being a regular drug user (cocaine, marijuana and LSD). Once she was asked, she denied the possibility of pregnancy and reported homosexual relationship. At ophthalmologic examination she presented visual acuity of counting fingers in both eyes. Anterior biomicroscopy revealed no cells in the anterior chamber and IOP was 12mmHg in both eyes. There were no signs of uveitis or inflammation. Fundoscopy showed 360-degree serous retinal detachment in right eye and a big inferior serous retinal detachment in the left eye. The patient was hospitalized for further investigation. The hypoteses of Vogt-Koyanagi-Harada syndrome, thrombotic thrombocytopenic purpura and cocaine-induced massive thrombosis were studied. Laboratory tests were normal, except blood count, which showed mild anemia and urine proteinuria 3+/4+. Later in the day, she developed severe abdominal pain, vaginal discharge and evolved to normal birth of full-term newborn, weighing 3050g. A 16,000 mIU/ml Beta-HCG test was confirmed later. One week later the retinal detachment was getting better in both eyes and visual acuity was 20/200 OU. After one month the patient presented visual acuity of 20/60 OU. Some hypotheses were raised to try to justify the patient's condition. It was possible to observe diffuse vascular narrowing and pathological arteriovenous crossing on retinography, which suggests previous chronic arterial hypertension. In addition, the increase in blood pressure associated with proteinuria suggests a Hypertensive Disorders of Pregnancy, such as pre-eclampsia. Finally, recent use of cocaine may have caused an even greater increase in pressure as well as vasoconstriction which may have led to choroidal ischemia causing a serous retinal detachment.

Area

CLINICAL CASE

Authors

Letícia Torres Elias Silva, Rafael Mourão Agostini, Luis Felipe da Silva Alves Carneiro, Wilton Feitosa de Araujo, Carlos Bernardo Moura Dalle, Amanda Lima Oliveira, Neiffer Nunes Rabelo, Renata de Sousa Carneiro