Purtscher-like retinopathy associated with squamous cell carcinoma of the cervix.
OBJECTIVE
To describe a previously unreported case of Purtscher-like retinopathy secondary to severe acute renal failure associated with squamous cell carcinoma of the cervix.


METHODS
This is a case report.


RESULTS
A 31-year-old female presented with a week history of acute abdominal pain, vomiting and severe renal failure followed by a sudden onset of bilateral visual loss. Vision was hand movement in either eye with central scotoma. Ophthalmic examination demonstrated bilateral retinal thickening and whitening with intraretinal hemorrhages localized to the peripapillary area, consistent with the diagnosis of Purtscher-like retinopathy. Further systemic examination revealed bilateral hydronephrosis secondary to underlying undiagnosed cervical carcinoma. Patient was treated with a short course of high-dose steroids. At 2 months, patient vision remained poor despite the resolution of retinal edema and hemorrhages.


CONCLUSIONS
This case serves as the first report of Purtscher-like retinopathy secondary to acute renal failure associated with cervical carcinoma, expanding the list of causes of Purtscher's or Purtscher-like retinopathies. In the presence of significant uremia and absence of previously known association, the authors postulate that the sudden surge of uremia causes increase of endothelin-1 (a potent vasoconstrictor), resulting in downstream endothelin-induced vasculopathy with subsequent occlusion of the pre-capillary arteriolar network.
Newcastle Eye Centre, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. ting.darren@gmail.com.
Darren Shu Jeng
http://orcid.org/0000-0003-1081-1141
DSJ
Ting
Sunderland Eye Infirmary, Sunderland, SR2 9HP, UK.
Jonathan
J
Smith
Newcastle Eye Centre, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
Stephen James
SJ
Talks
D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009898:Optic Disk / Q000473:pathology*; D010211:Papilledema / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D041623:Tomography, Optical Coherence / Q000379:methods*; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000175:diagnosis; D014792:Visual Acuity
Cervical carcinoma; Purtscher-like retinopathy; Purtscher’s retinopathy; Renal failure; Uremia