Purtscher-like retinopathy following coronary artery bypass grafting in an antiphospholipid syndrome patient: a case report

BMC Ophthalmology

Case Report

Sherin Hassan Sadek¹  Ahmed Ameen Ismail¹  Ragai Magdy Hatata¹  Heba Eid Tolba² 

[1] Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt;Department of Rheumatology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt;

关键词: Purtscher retinopathy;    Purtscher-like retinopathy;    Coronary artery bypass grafting;    Antiphospholipid syndrome;    Case report;   

DOI  :  10.1186/s12886-023-02935-z

 received in 2023-02-28, accepted in 2023-04-21,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPurtscher retinopathy is a rare occlusive microangiopathy comprising a constellation of retinal signs including cotton wool spots, retinal hemorrhages and Purtscher flecken. While classical Purtscher must be antedated by a traumatic incident, Purtscher-like retinopathy is used to refer to the same clinical syndrome in the absence of trauma. Various non-traumatic conditions have been associated with Purtscher-like retinopathy e.g. acute pancreatitis, preeclampsia, parturition, renal failure and multiple connective tissue disorders. In this case study, we report the occurrence of Purtscher-like retinopathy following coronary artery bypass grafting in a female patient with primary antiphospholipid syndrome (APS).Case presentationA 48-year-old Caucasian female patient presented with a complaint of acute painless diminution of vision in the left eye (OS) that occurred approximately two months earlier. Clinical history revealed that the patient underwent coronary artery bypass grafting (CABG) two months earlier and that visual symptoms started 4 days thereafter. Furthermore, the patient reported undergoing percutaneous coronary intervention (PCI) one year before for another myocardial ischemic event. Ophthalmological examination revealed multiple yellowish-white superficial retinal lesions i.e. cotton-wool spots, exclusively in the posterior pole and predominantly macular within the temporal vascular arcades only OS. Fundus examination of the right eye (OD) was normal and the anterior segment examination of both eyes (OU) was unremarkable. A diagnosis of Purtscher-like retinopathy was made based on clinical signs, suggestive history and consolidated by fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCTA) of macula, optic nerve head (ONH) according to the diagnostic guidelines of Miguel. The patient was referred to a rheumatologist to identify the underlying systemic cause and was diagnosed with primary antiphospholipid syndrome (APS).ConclusionsWe report a case of Purtscher-like retinopathy complicating primary antiphospholipid syndrome (APS) following coronary artery bypass grafting. This conveys a message to clinicians that patients presenting with Purtscher-like retinopathy should undergo meticulous systemic work-up in order to identify potentially life-threatening underlying systemic diseases.

【 授权许可】

CC BY   
© The Author(s) 2023

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