Rana Ramesh, Thakali Ashwin, Shrestha Umid Kumar, Sharma Rabin, Chapagain Senny
Department of Gastroenterology and Hepatology, Nepal Mediciti Hospital, Lalitpur, NPL.
Department of Ophthalmology, Nepal Mediciti Hospital, Lalitpur, NPL.
Cureus. 2024 Feb 15;16(2):e54234. doi: 10.7759/cureus.54234. eCollection 2024 Feb.
Acute pancreatitis is a pancreatic inflammatory disorder that often leads to multi-organ dysfunction associated with systemic inflammatory response. Optic neuropathy is an extremely rare ocular manifestation that can occur especially in alcoholic pancreatitis most likely due to ischemic complications and is a vision-threatening condition that has to be recognized early as it can cause permanent vision loss. In this case report, a 51-year-old lady, an occasional consumer of alcohol, post-cholecystectomy status, presented with severe abdominal pain of four days' duration associated with multiple episodes of vomiting. She was diagnosed with moderate to severe acute pancreatitis and needed ionotropic support initially. She had improvement in gastrointestinal symptoms. However, she had left peri-orbital pain and lacrimation with blurring of vision on Day 11 of illness. Subsequently, an ophthalmic evaluation revealed optic disc oedema and a mild decrease in visual acuity but normal visual field and colour vision. Therefore, left optic neuropathy was diagnosed and a high-dose oral steroid was started on a tapering dose. Follow-ups after four and 12 weeks showed significant improvement in optic disc oedema and other symptoms. Therefore, though optic neuropathy is rarely reported in acute pancreatitis, it has to be considered in clinical practice along with Purtscher-like retinopathy, which presents with ocular symptoms in acute pancreatitis.
急性胰腺炎是一种胰腺炎症性疾病，常导致与全身炎症反应相关的多器官功能障碍。视神经病变是一种极其罕见的眼部表现，尤其可能发生在酒精性胰腺炎中，最有可能是由于缺血性并发症所致，是一种威胁视力的疾病，由于可导致永久性视力丧失，必须尽早识别。在本病例报告中，一名51岁的女性，偶尔饮酒，胆囊切除术后，出现持续四天的严重腹痛，并伴有多次呕吐。她被诊断为中度至重度急性胰腺炎，最初需要血管活性药物支持。她的胃肠道症状有所改善。然而，在患病第11天，她出现左眼眶周疼痛、流泪及视力模糊。随后，眼科评估显示视神经乳头水肿，视力轻度下降，但视野和色觉正常。因此，诊断为左眼视神经病变，并开始给予大剂量口服类固醇药物，剂量逐渐递减。四周和十二周后的随访显示视神经乳头水肿及其他症状有显著改善。因此，尽管急性胰腺炎中很少报告视神经病变，但在临床实践中必须将其与急性胰腺炎中出现眼部症状的类Purtscher视网膜病变一起考虑。
