Purtscher-like Retinopathy as a Rare Presentation of Cryoglobulinemia

Abstract

Purtscher's retinopathy is a rare condition that is noted in cases related to various types of trauma. The characteristic finding in the fundus is the presence of multiple Purtscher flecken. Purtscher-like retinopathy has a similar presentation in the fundus but is not associated with trauma. We report the case of a 55-year-old male who presented a severe visual loss during course of a hepatitis C infection. Ophthalmic examination indicated peripapillary cotton wool spots and superficial retinal whitening in the macula. Cryoglobulinemia complicating hepatitis C was discovered in this patient. Purtscher-like retinopathy as a rare presentation of cryoglobulinemia should be considered in patients with a history of hepatitis infection.

Keywords: Cryoglobulinemia; Hepatitis C; Purtscher.

Figures

Figure 1

Fundus examination of the right eye showing multiple cotton wool spots of various sizes surrounding the optic disc and retinal whitening in the macula. The left eye had superficial retinal hemorrhages and small cotton wool spots

Figure 2

Fluorescein angiography indicated that the arm-to-retina circulation time was 33 s, the areas of retinal vascular nonperfusion in the right macula corresponded to the cotton wool spots

Figure 3

The right eye 4 months after treatment shows that the superficial retinal whitening, cotton wool spots, and retinal hemorrhages all resolved; however, optic atrophy with arterial narrowing was evident