P1113 - I Cannot See Your Face! A Case of Acute Pancreatitis With Purtscher's Retinopathy

Abdelrhman M. Abo-Zed, MD, Melissa Chrites, DO, Erica O'Kane, MD, Syed Zaidi, MD
University of Pittsburgh Medical Center, Pittsburgh, PA

Introduction: Purtscher-like retinopathy is acquired due to hemorrhagic or vasoocclusive vasculopathy associated with acute pancreatitis and other systemic diseases 1. It is associated with severe vision. Recent studies suggested ophthalmoscopy performed within the first 24 hours of developing acute pancreatitis was a good indicator for predictor of disease evolution, outcome and overall poor prognosis 2. We present a rare case of a young African American male who had experienced acute vision loss in the setting of severe alcoholic pancreatitis.

Case Description/Methods: A 34-year-old African American male with severe abdominal pain. He has a history of alcohol use disorder. His abdominal pain is sharp and radiates to his back. His last alcohol ingestion was 36 hours ago and denies any other ingestions or drug use. On presentation, vital signs reveal he has tachycardia and mildly hypertensive. Physical exam is within normal limits other than epigastric tenderness. Labs unremarkable other than lipase elevated to 3 times the upper normal limit. Intravenous fluids were provided as well as pain control and patient was placed on a withdrawal assessment scale. Within 12 hours of admission, the patient presented with alcoholic hallucinosis and complained of loss of visual acuity with inability to recognize facial features. Fundoscopy revealed retinal whitening bilaterally, Intraretinal flame heme along inferior arcade of the right eye, cherry red spot of the left eye within the macula, consistent with Purtscher-like retinopathy in the setting of acute pancreatitis declaring him legally blind. Patient signed a 302 to receive further inpatient psychiatric care.



Discussion: The acute psychosis from alcohol compounded his complaint of acute vision loss. Purtscher retinopathy is a rare complication of acute pancreatitis and should be suspected when patients have changes in visual acuity. The etiology is unclear, however in relation to pancreatitis, the condition may be caused by complement induced granulocyte activity causing cotton wool spots, retinal hemorrhages, and papilledema [2]. Other than high dose steroids being used, there are no current evidence-based treatment options that may reduce morbidity. Close follow up with a retinal specialist is required. This case reports certainly presents a rare and interesting complication of acute pancreatitis. Further clinical studies are required to investigate treatment options for Purtcher's retinopathy.




Disclosures:


Abdelrhman M. Abo-Zed, MD, Melissa Chrites, DO, Erica O'Kane, MD, Syed Zaidi, MD. P1113 - I Cannot See Your Face! A Case of Acute Pancreatitis With Purtscher's Retinopathy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.