title: Malignant hypertensive retinopathy as a presenting sign of an occult dead fetus.
abstract: We report one case of malignant hypertensive retinopathy as a presenting sign of fetal death in utero. Ophthalmic examination (including intravenous fluorescein angiography and optical coherence tomography) and obstetric and systemic evaluation were performed, providing a multidisciplinary approach. A 33-year-old overweight woman (body mass index 47 kg/m(2)) with no systemic or ocular known disease was admitted to our emergency department with a one-week history of bilateral vision loss and no systemic complaints. On examination, best corrected visual acuity was 1/10 in the right eye and 1/10 in the left eye. Anterior segment examination of both eyes was unremarkable. Ophthalmoscopic fundus findings included bilateral optic disc edema, diffuse cotton wool spots, intraretinal exudates, retinal hemorrhages, and multiple serous retinal detachments involving both maculae. Physical examination revealed a blood pressure of 220/110 mmHg. Further systemic workup revealed a previously unknown 35-week pregnancy with a dead fetus. An emergency cesarean section was performed. Pre-eclampsia is a life-threatening disorder for both mother and fetus. This case highlights the need to rule out pre-eclampsia in all women of childbearing age presenting with ocular signs of malignant hypertension, even without external signs of pregnancy.
authors.affiliation: Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Araújo
authors.affiliation: Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Tavares-Ferreira
authors.affiliation: Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal ; Department of Sense Organs, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Penas
authors.affiliation: Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal ; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Figueira
authors.affiliation: Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal.
authors.forename: Flávio Prézia
authors.initials: FP
authors.lastname: Paiva
authors.affiliation: Ophthalmology Department, São João Hospital, University of Porto, Porto, Portugal ; Department of Sense Organs, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Falcão-Reis
keywords: hypertensive retinopathy; pre-eclampsia; vision loss