Ustaoğlu Melih, Önder Feyza, Solmaz Nilgün, Öztürk Savaş, Ayer Mesut
University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey.
University of Health Sciences, Haseki Training and Research Hospital, Ophthalmology Clinic, İstanbul, Turkey.
Turk J Ophthalmol. 2017 Dec;47(6):348-350. doi: 10.4274/tjo.66502. Epub 2017 Dec 25.
A 25-year-old woman presented with acute bilateral blurred vision and history of headache, dizziness, and syncope for three days. Her visual acuity was 20/60 in both eyes. Fundoscopy revealed multiple bilateral peripapillary yellow-white patches like cotton wool spots, intraretinal hemorrhages and macular edema. The patient was diagnosed with Purtscher-like retinopathy based on the retinal findings and lack of trauma history. She was urgently admitted to the nephrology clinic due to thrombotic microangiopathy findings (hemoglobinemia, thrombocytopenia, and acute renal failure). After excluding thrombotic microangiopathy, the patient was diagnosed with atypical hemolytic uremic syndrome (aHUS) with the clinical and laboratory findings. Eculizumab treatment was added to hemodialysis and plasmapheresis therapy. Three months after starting treatment, retinal lesions regressed and visual acuity increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of Purtscher-like retinopathy associated with aHUS.
一名25岁女性因急性双侧视力模糊以及头痛、头晕和晕厥病史三天前来就诊。她双眼视力均为20/60。眼底镜检查发现双侧视乳头周围有多个黄白色斑片，类似棉絮斑，视网膜内出血和黄斑水肿。基于视网膜检查结果及无外伤史，该患者被诊断为类Purtscher视网膜病变。由于血栓性微血管病表现（血红蛋白血症、血小板减少症和急性肾衰竭），她被紧急收治入肾病科门诊。排除血栓性微血管病后，根据临床和实验室检查结果，该患者被诊断为非典型溶血性尿毒症综合征（aHUS）。在血液透析和血浆置换治疗基础上加用依库珠单抗治疗。开始治疗三个月后，视网膜病变消退，双眼视力提高到20/20。据我们所知，这是首例报道的与aHUS相关的类Purtscher视网膜病变病例。
