Purtscher-like retinopathy in a 56-year-old thai female with anti-glomerular basement membrane glomerulonephritis

Purpose: To report a case of Purtscher-like retinopathy in an anti-glomerular basement membrane glomerulonephritis in a 56-year-old Thai female. Method: Observational case report. Results: A 56-year-old Thai female was referred to Naresuan university hospital with anemia and pitting edema in both legs. She had underlying diseases of hypertension, hypercholesterolemia and chronic renal failure with anemia. Before her referral, she was treated by an internist at a provincial hospital. Because of deterioration of creatinine level and anemic symptoms, she was advised to see a nephrologist for the diagnosis of causative pathology and treatment. A re-evaluation of chronic renal failure was done. The results of laboratory investigation were creatinine level of 2.42 mg/dl, blood urea nitrogen (BUN) 44 mg/dl and the urinalysis found microscopic hematuria. Further evaluations for hematuria; vaginoscopy, cystoscopy and ultrasonography of genitourinary system were performed, but the outcome was normal. The result of a renal biopsy was anti-glomerular basement membrane glomerulonephritis. Hemodialysis and total plasma exchange were done several times to reduce the circulating antibody of the anti-glomerular basement membrane level. During her admission, the patient complained of sudden blurred vision in both eyes after the ninth total plasma exchange. She had no previous ocular problems nor physical trauma. The ocular examination showed visual acuity of counting fingers in both eyes. Anterior segment was normal for her age. The posterior segments showed retinal thickening around the posterior poles with clear intervening zones in both eyes with some intra-retinal hemorrhage, which was consistent with the earlier-diagnosed Purtscherlike retinopathy. The pathogenesis of Purtscher-like retinopathy was investigated with negative results. During counseling, the patient and her family chose observation instead of active treatment. The patient was discharged and followed-up at the out-patient unit of the ophthalmology department of the Naresuan university hospital. Conclusion: Purtscher-like retinopathy is a rare ocular disease with unknown pathogenesis. There are many diseases reported to be associated with Purtscher-like retinopathy. In this case, we found Purtscher-like retinopathy in a patient with anti-glomerular basement membrane glomerulonephritis.