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First Author: R.Massa PORTUGAL
Co Author(s): M. Macedo M. Gomes M. Lume M. Santos
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To present a case report of the evolution of Purtscher-like retinopathy in a Klatskin tumour.
Ophthalmology Department of Centro Hospitalar do Porto Hospital de Santo António in Oporto, Portugal.
Patients data including clinical ophthalmologic evaluations complemented with retinographies and retina and optic nerve optical coherence tomography (OCT). General surgery and Oncology evaluations supported by exams such as blood tests, abdominal ultrassonographies, computerized axial tomography and magnetic resonance cholangiopancreatography were also consulted.
A 53-year-old man with multiple cardiovascular risk factors was admitted to the Emergency Department with jaundice, nausea, coluria and itch. Liver enzymes and bilirubin were elevated and an abdominal ultrasonography showed dilation of intrahepatic bile ducts. A magnetic resonance cholangiopancreatography suggested the presence of a Klastkin tumour (a cholangiocarcinoma). A biliary stent was inserted and was complicated with severe acute pancretitis. The patient reported progressive visual loss. The ophthalmologic evaluation revealed the best corrected vision of 0.6 in the right eye (RE) and of 0.5 in the left eye (LE); biomicroscopy of anterior segment showed scleral icterus and fundoscopy revealed peripapillary cotton-wool spots, optic disc edema and RPE hypo and hyperpigmentation in the middle peripheral retina in both eyes with an intraretinal hemorrhage in the left inferior temporal arcade without visualization of the inferior temporal vein. The patient iniated palliative chemotherapy with an improvement of his general state. Five months later, his best corrected vision was of 1.0 in both eyes, biomicroscopy showed anicteric sclerae and fundoscopy revealed soft exudates in the right eye.
Purtscher-like retinopathy is associated with retinal haemorrhages and ischaemia problaby due to the complement-mediated leukoembolization. These disastrous consequences should be carefully monitorized to provide prompt treatment. This case is an example of the complex management of ocular complications in this life-threatning clinical context.