, Volume 30, Issue 1, pp 112-113
Date: 16 Oct 2009

Purtscher retinopathy as an initial presentation of thrombotic thrombocytopenic purpura

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Purtscher retinopathy, first described secondary to severe head trauma, is characterized by retinal haemorrhages and cotton-wool spots in the posterior pole of the eye. It has been rarely associated with thrombotic thrombocytopenic purpura (TTP) and it is believed that abnormal platelet aggregations in TTP caused the microembolic occlusion of retinal precapillary arterioles. We present a case of Purtscher retinopathy as an initial presentation of TTP.

A 20-year-old woman was referred to ophthalmology unit for bilateral blurring of vision. She was admitted to the medical ward the previous day for evaluation of high grade fever, generalised petechiae, facial edema and pleural effusion of 1-week duration. Full blood count showed low haemoglobin of 86 g/l (normal 130–177 g/l), white cell count of 2.2 × 109 cells/l (normal 4.0–11.0 × 109 cells/l) with 29% eosinophilia and low platelet count of 145 × 109 cells/l (normal 150–400 × 109 cells/l). Peripheral blood smear showed schistocytosis but ...