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

Abstract

Background: We report a rare case of left eye Purtscher-like retinopathy following history of right endogenous panophthalmitis. Case presentation: A 61-year-old male with uncontrolled diabetes mellitus and hypertension presented with a 5-day history of right eye redness, swelling, and progressive vision loss. Systemic symptoms included vomiting, diarrhea, and left lower limb redness. On examination, the right eye had no light perception with signs of panophthalmitis, while the left eye had reduced vision (6/18), with early fundus changes. B-scan of the right eye revealed vitritis, choroidal abscess, retinal detachment, and scleral thickening. Vitreous cultures confirmed Staphylococcus aureus. The patient was treated with intravitreal vancomycin and ceftazidime, followed by enucleation. He received intravenous antibiotics (ciprofloxacin, cefazolin, later switched to cloxacillin) for one month as per infectious disease advice. Subsequently on day 7 of admission, the left eye showed worsening cotton wool spots without vitritis or choroiditis. Intravitreal antibiotics were administered prophylactically; vitreous cultures were negative. 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-like retinopathy. Nevertheless, a meticulous follow-up is mandatory to avoid its severe complications.