Ting Darren Shu Jeng, Smith Jonathan, Talks Stephen James
Newcastle Eye Centre, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
Sunderland Eye Infirmary, Sunderland, SR2 9HP, UK.
Int Ophthalmol. 2018 Feb;38(1):389-393. doi: 10.1007/s10792-017-0461-2. Epub 2017 Feb 6.
To describe a previously unreported case of Purtscher-like retinopathy secondary to severe acute renal failure associated with squamous cell carcinoma of the cervix.
This is a case report.
A 31-year-old female presented with a week history of acute abdominal pain, vomiting and severe renal failure followed by a sudden onset of bilateral visual loss. Vision was hand movement in either eye with central scotoma. Ophthalmic examination demonstrated bilateral retinal thickening and whitening with intraretinal hemorrhages localized to the peripapillary area, consistent with the diagnosis of Purtscher-like retinopathy. Further systemic examination revealed bilateral hydronephrosis secondary to underlying undiagnosed cervical carcinoma. Patient was treated with a short course of high-dose steroids. At 2 months, patient vision remained poor despite the resolution of retinal edema and hemorrhages.
This case serves as the first report of Purtscher-like retinopathy secondary to acute renal failure associated with cervical carcinoma, expanding the list of causes of Purtscher's or Purtscher-like retinopathies. In the presence of significant uremia and absence of previously known association, the authors postulate that the sudden surge of uremia causes increase of endothelin-1 (a potent vasoconstrictor), resulting in downstream endothelin-induced vasculopathy with subsequent occlusion of the pre-capillary arteriolar network.
描述一例先前未报道的与宫颈癌相关的严重急性肾衰竭继发的类Purtscher视网膜病变。
这是一篇病例报告。
一名31岁女性，有一周的急性腹痛、呕吐和严重肾衰竭病史，随后突然出现双侧视力丧失。双眼视力为手动，伴有中心暗点。眼科检查显示双侧视网膜增厚、变白，视网膜内出血局限于视乳头周围区域，符合类Purtscher视网膜病变的诊断。进一步的全身检查发现双侧肾积水继发于未确诊的宫颈癌。患者接受了短期大剂量类固醇治疗。两个月时，尽管视网膜水肿和出血消退，但患者视力仍很差。
该病例是宫颈癌相关急性肾衰竭继发类Purtscher视网膜病变的首例报告，扩展了Purtscher或类Purtscher视网膜病变的病因清单。在存在严重尿毒症且无先前已知关联的情况下，作者推测尿毒症的突然激增导致内皮素-1（一种强效血管收缩剂）增加，导致下游内皮素诱导的血管病变，随后毛细血管前小动脉网络闭塞。
