Aziz Rem, Lo Cody, Denstedt James T, Hurley Bernard
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Ophthalmology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Case Rep Ophthalmol. 2024 Oct 2;15(1):710-716. doi: 10.1159/000530973. eCollection 2024 Jan-Dec.
This is an observational case report to detail a novel case of scleroderma renal crisis presenting as bilateral exudative retinal detachments in a patient with newly diagnosed systemic sclerosis. An otherwise healthy 58-year-old female presented primarily with vision complaints and was found to have malignant hypertension (230/120 mm Hg) and bilateral exudative retinal detachment on dilated fundus examination and macular OCT scan. Further history revealed sclerodactyly, mild dysphagia, and dyspnea. She was diagnosed with diffuse systemic sclerosis and Sjogren's syndrome complicated by an episode of scleroderma renal crisis based on initial medical workup. She was admitted to intensive care for management of refractory hypertension with IV antihypertensive therapy. Three months after treatment, her visual symptoms and ocular findings resolved. The presence of exudative retinal detachment among other signs of hypertensive retinopathy warrants thorough systemic screening for underlying causes of malignant hypertension, including systemic sclerosis. Treatment of the underlying disease with urgent antihypertensive therapy resolved the exudative retinal detachments and restored vision in the case of a scleroderma renal crisis.
这是一篇观察性病例报告，详细介绍了一例硬皮病肾危象的新病例，该病例表现为一名新诊断为系统性硬化症的患者出现双侧渗出性视网膜脱离。一名原本健康的58岁女性主要因视力问题就诊，在散瞳眼底检查和黄斑OCT扫描中发现患有恶性高血压（230/120 mmHg）和双侧渗出性视网膜脱离。进一步询问病史发现有指端硬化、轻度吞咽困难和呼吸困难。根据初步检查，她被诊断为弥漫性系统性硬化症和干燥综合征，并并发了一次硬皮病肾危象。她因难治性高血压接受静脉降压治疗而入住重症监护病房。治疗三个月后，她的视觉症状和眼部检查结果消失。除高血压性视网膜病变的其他体征外，渗出性视网膜脱离的存在需要对恶性高血压的潜在病因进行全面的系统筛查，包括系统性硬化症。在硬皮病肾危象的病例中，通过紧急降压治疗对基础疾病进行治疗，解决了渗出性视网膜脱离并恢复了视力。
