Viola Francesco, Vezzola Diego, Villani Edoardo, Mapelli Chiara, Barteselli Giulio, Ratiglia Roberto
U.O. Oculistica, Dipartimento di Scienze Cliniche e di Comunità, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan - Italy.
Eur J Ophthalmol. 2013 Jul-Aug;23(4):601-603. doi: 10.5301/ejo.5000290.
To describe a case of severe Purtscher-like retinopathy during an episode of septicemic diffused intravascular coagulation (DIC) in a child with severe nephrotic syndrome.
Case report.
A 5-year-old girl with a history of steroid-sensitive nephrotic syndrome was admitted for worsening symptoms of the systemic disease. Laboratory studies revealed evidence of DIC during an episode of septicemia. Ten days later, she had a sudden and severe bilateral visual loss. Her visual acuity was hand motion in either eye. Fundus examination showed ischemic retinal whitening and retinal hemorrhages. Fluorescein angiography revealed obstruction of arterioles and venules at the posterior pole. Three weeks later, ischemic retinal blanching and hemorrhages resolved in both eyes; visual acuity improved to 20/250 and 20/200 in right and left eye, respectively. No further functional improvement was noted after 3 months, due to diffuse thinning of the inner retina architecture as shown by optical coherence tomography.
Purtscher-like retinopathy can occur in patients with septicemic DIC and nephrotic syndrome.
描述一例患有严重肾病综合征的儿童在败血症性弥散性血管内凝血（DIC）发作期间出现的严重类Purtscher视网膜病变。
病例报告。
一名有类固醇敏感性肾病综合征病史的5岁女孩因全身性疾病症状恶化入院。实验室检查显示败血症发作期间存在DIC证据。10天后，她突然出现严重的双侧视力丧失。双眼视力均为手动。眼底检查显示视网膜缺血性变白和视网膜出血。荧光素血管造影显示后极部小动脉和小静脉阻塞。三周后，双眼缺血性视网膜变白和出血消退；右眼和左眼视力分别提高到20/250和20/200。3个月后未观察到进一步的功能改善，光学相干断层扫描显示视网膜内层结构弥漫性变薄。
类Purtscher视网膜病变可发生于败血症性DIC和肾病综合征患者。
