Case of the Month I June 2019 Answer

Legacy Post
June 29, 2019

The Case

The patient had a clinical presentation that resembled Purtcher's retinopathy, which features multiple cotton-wool spots.  Purtcher's retinopathy is most commonly seen in pancreatitis, long-bone fractures, or severe blunt chest trauma. Disc edema and cystoid macular edema are atypical for this condition. Inflammatory retinitis, such as lupus erythematosus, can result in vascular occlusions with cotton-wool spots and edema.

The missing piece of information was the blood pressure, which was 200/110. The patient had hypertensive retinopathy, and underlying renal disease was suspected. She was started on prednisone and anti-hypertensive therapy. A kidney biopsy showed IgA nephropathy, also known as Berger's disease. The blood pressure quickly normalized and the vision improved rapidly. When last seen, the visual acuity was 20/30-1 OD and 20/25-1 OS. Unfortunately, the acute insult resulted in renal failure, and she had a kidney transplant 7 months after her initial presentation. When last seen, she was on CellCept and prednisone 10 mg every other day.

Berger's disease is an autoimmune condition and is the most common cause of glomerulonephritis in the world and results in mild or severe renal disease. Treatment can include immunosuppression, plasmapheresis, and hemodialysis.

Reference

Taban A, Chand D, Sears JE. Ocular findings in IgA nephropathy with renal failure and hypertension. J Petiatr Ophthalmol Strabismus 2006;43:378-380.

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