A rare case of left eye Purtscher-like retinopathy following history of right eye endogenous panophthalmitis- A case report

Background: We report a rare case of left eye Purtscher-like retinopathy following history of right endogenous panophthalmitis. Result: A 61-year-old gentleman with underlying uncontrolled diabetes mellitus and hypertension. Initially presented with right eye redness and swelling for 5 days, associated with progressive blurring of vision and subsequently lost of vision for 4 days. Preceded with loose stool, vomiting and left lower limb redness for 4 days. Otherwise, no fever, no eye trauma. At presentation, visual acuity right eye was light perception and left eye was 6/18 with pinhole 6/9. RAPD was positive on RE with limitation of all extraocular muscle. Anterior segment of right eye revealed endogenous features with presence of fibrin in anterior chamber. For left eye, anterior segment was unremarkable. Fundus examination of right eye, no fundus view and proceeded with B scan showed vitritis with multiple loculation, choroidal abcess and retinal detachment with scleral thickening. Left eye fundus showed optic disc pink, CDR 0.3, 2 dot blot haemorrhages over macula, 1 whitish lesions superior to optic disc and 1 whitish lesion at inferotemporal arcade, no vitirits, no choroiditis. Proceeded with right eye intravitreal tapping and intravitreal Vancomycin and Ceftazidime for 2 times and enucleation was done. Intravenous Ciprofloxacin and Cefazolin was given for 7 days then change to intravenous cloxacillin due to vitreous culture and sensitivity showed Staphylococcus Aureus for total 1 month as plan by infectious disease team. After few days, left eye fundus showed worsening cotton wool spot over inferotemporal arcade but no vitritis, choroiditis or vasculitis seen. Left eye intravitreal Vancomycin and Ceftazidime was commenced for 3 times as suggested by medical retina team. Vitreous gram stain and culture and sensitivity revealed no growth. Conclusion: The natural history of Purtscher retinopathy which should not be ignored in complex clinical contexts even when there is no history of trauma. Hence, all cases with cotton wool spots with central and paracentral involvement and with few haemorrhages should be viewed with high suspicion of Purtscher retinopathy. Nevertheless, a meticulous follow-up is mandatory in order to avoid its severe complications.