Blind After a Binge: Purtscher-like Retinopathy in Acute Alcoholic Pancreatitis

Abstract

Purtscher-like retinopathy is an occlusive microvasculopathy that causes sudden onset vision loss of varying severity. The condition is a rare complication of acute pancreatitis and is scarcely documented in the literature. In addition, it is vision-threatening, and there are no evidence-based therapies available. We report a 37-year-old woman presenting with abdominal pain and nausea in the setting of heavy alcohol use. She was diagnosed with acute pancreatitis. During hospitalization, she developed acute visual disturbance and was found to have significantly diminished visual acuity. A dilated funduscopic examination demonstrated multiple retinal cotton wool spots bilaterally and macular edema. The patient was diagnosed with Purtscher-like retinopathy in the setting of acute pancreatitis. Although the prognosis for her vision was guarded, given the ischemic nature of the insult, she had subjective improvement in visual acuity during the remainder of the hospital course with symptomatic management.

Purtscher’s-like retinopathy as a rare complication of acute alcoholic pancreatitis

“…Its occurrence has been reported in many disorders such as antibiotic anaphylaxis, myocardial infarction, connective tissue diseases, renal failure, childbirth, and bone marrow transplant [5][6][7][8]. Furthermore, Purtscher's-like retinopathy is rare with an incidence rate of less than 0.24 cases per million, and it is also a complication of AP [5]. So far, several such cases have been reported in the literature [5,[9][10][11].…”

“…Purtscher’s-like retinopathy is associated with non-traumatic causes [ 5 ]. Its occurrence has been reported in many disorders such as antibiotic anaphylaxis, myocardial infarction, connective tissue diseases, renal failure, childbirth, and bone marrow transplant [ 5 – 8 ].…”

“…Furthermore, Purtscher’s-like retinopathy is rare with an incidence rate of less than 0.24 cases per million, and it is also a complication of AP [ 5 ]. So far, several such cases have been reported in the literature [ 5 , 9 – 11 ]. It must be emphasized that Purtscher’s-like retinopathy occurs primarily in acute alcoholic pancreatitis (AAP), and there are few case reports of this type of ocular disorder in acute non-alcoholic pancreatitis: in the context of a Klatskin tumour or an acute kidney injury [ 12 , 13 ].…”

“…Nevertheless, there is only 1 case report of this retinopathy in acute non-alcoholic pancreatitis without concomitant diseases [ 14 ]. This ocular disorder manifests by sudden visual loss and typical changes in fundus examination, which is caused by a vaso-occlusive microvasculopathy [ 5 ]. The pathophysiology of Purtscher’s-like retinopathy remains unclear, which contributes to the lack of targeted therapy of this pathology condition.…”

“…Nevertheless, the incidence of sudden visual loss associated with changes in the retina ( inter alia retinal haemorrhages and oedema) in AP was found to be 2% [ 9 ]. Purtscher’s-like retinopathy represents one of the eye disorders in AAP [ 5 , 9 – 11 ] and only rarely acute non-alcoholic pancreatitis [ 14 ]. The exact mechanisms that lead to its occurrence are still undiscovered.…”