Purtscher’s retinopathy and renal cortical necrosis: two rare vaso-occlusive complications in a patient with acute pancreatitis: a case report

Abstract

BackgroundPurtscher’s retinopathy and renal cortical necrosis are two rare vaso-occlusive complications of acute pancreatitis. Purtscher’s retinopathy causes sudden impairment of vision, which was first reported in a patient with head trauma. Subsequently, it was also reported as a complication of acute pancreatitis and few other clinical conditions. Acute pancreatitis also rarely causes renal cortical necrosis leading to acute kidney injury. However, the simultaneous presence of both complications is rarely reported.Case presentationA 20-year-old Bengali man presented to our hospital with a history of acute upper abdominal pain, vomiting, anuria, and disorientation. He was ultimately found to have bilateral complete blindness due to Purtscher’s retinopathy and acute kidney injury due to renal cortical necrosis, as sequelae of acute pancreatitis. He became dialysis-dependent, his vision did not recover, and he died 16 months after diagnosis.ConclusionsThis case highlights Purtscher’s retinopathy and renal cortical necrosis might be considered as a recognized pair complication of acute pancreatitis.

Purtscher-like Retinopathy in a Patient with Acute Pancreatitis: A Case Report and Literature Review

“…27,29,31 Most patients reported improved vision within 2-3 months, while in one of the cases the visual defects were permanent, and two of the patients died soon afterwards, hence there was no ophthalmology follow up (Table 1). 16,26,38 The low reporting rate of pancreatitis-induced Purtscher-like retinopathy could be due to low incidence of this pathology in the setting of acute pancreatitis or due to the low recognition rates of the association between visual pathology and acute pancreatitis. The latter could be due to several confounding factors.…”

Purtscher-like retinopathy in patients with COVID-19

“…We describe two unique cases wherein our patients experienced sudden bilateral vision loss after incidentally being diagnosed with COVID-19. Commonly reported causes of Purtscher-like retinopathy include acute pancreatitis, 14 , 15 renal failure, 16 , 17 , 18 dermatomyositis, 19 , 20 , 21 and disseminated intravascular coagulation (DIC). 13 , 22 In order to make a diagnosis of Purtscher-like retinopathy, the patient must have three of the following five criteria: Purtscher flecken, retinal hemorrhages, cotton-wool spots, probably explanatory etiology, and complementary investigation compatible with diagnosis.…”

An unusual association between pancreatic cancer and Purtscher-like retinopathy: Presentation of a unique case

“…Besides the classic Purtscher's retinopathy, a similar clinical retinopathy having non-traumatic etiology has also been described. This pathology, designated in the Literature as Purtscher's-like retinopathy [4] , is usually associated with acute pancreatitis [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , whose detection could be an indicator of multi-organ failure with a poor prognosis [14] . The possible pathophysiology lies in the pancreatic injury or inflammation that causes the release of activated proteases such as trypsin, which in turn activate the complement system.…”