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Abstract：
BACKGROUND: Purtscher\'s retinopathy characterized by the appearance of cotton-wool spots and intraretinal hemorrhage at the posterior pole that commonly occurs after severe head and chest trauma. We report a patient who presented with multiple white retinal patches and retinal hemorrhage forty-two days after a severe thoracoabdominal trauma, which was misdiagnosed as Purtscher\'s retinopathy.
METHODS: A middle-aged woman presented to the eye clinic complaining of decreased vision and distortion in the right eye forty-two days after thoracoabdominal trauma. Upon first glance at her fundal appearances with multiple white retinal patches and retinal hemorrhage, we considered it to be bilateral Purtscher\'s retinopathy. No specific treatment was given to her. Ten days later, the four white retinal patches in the right eye joined together with star-shaped hard exudates and radial folds in the macula. This was not consistent with the characteristics of Purtscher\'s retinopathy. In retrospect, we found that the onset time, shape, and location of the white retinal patches were not cotton-wool spots. A detailed history revealed that she had Staphylococcus aureus septicaemia due to abdominal incision infection, and she underwent intravenous antibiotic therapy. Fundus fluorescein angiography (FFA) revealed hyperpermeable vasculature and extensive fluorescence leakage in the middle and late stages. Optical coherence tomography (OCT) revealed highly reflective exudates in the neuroepithelium and macular edema in the right eye. Taking her history and the FFA and OCT results into consideration, she was diagnosed with bilateral endogenous endophthalmitis.
CONCLUSIONS: In the present case, multiple white patches and intraretinal hemorrhage at the posterior pole forty-two days after the trauma were not Purtscher\'s retinopathy. It was bilateral endogenous endophthalmitis. The subretinal abcesses that developed secondary to Staphylococcus aureus infection involved the macula causing decreased vision and distortion in the right eye. We concluded that in the case of multiple white retinal patches at the posterior pole in patients after trauma, especially in patients with infectious disease, Purtscher\'s retinopathy is not the only possible diagnosis. Correct diagnosis depends on reevaluation of the lesions by FFA and OCT, laboratory investigation and detailed history.
METHODS: A middle-aged woman presented to the eye clinic complaining of decreased vision and distortion in the right eye forty-two days after thoracoabdominal trauma. Upon first glance at her fundal appearances with multiple white retinal patches and retinal hemorrhage, we considered it to be bilateral Purtscher\'s retinopathy. No specific treatment was given to her. Ten days later, the four white retinal patches in the right eye joined together with star-shaped hard exudates and radial folds in the macula. This was not consistent with the characteristics of Purtscher\'s retinopathy. In retrospect, we found that the onset time, shape, and location of the white retinal patches were not cotton-wool spots. A detailed history revealed that she had Staphylococcus aureus septicaemia due to abdominal incision infection, and she underwent intravenous antibiotic therapy. Fundus fluorescein angiography (FFA) revealed hyperpermeable vasculature and extensive fluorescence leakage in the middle and late stages. Optical coherence tomography (OCT) revealed highly reflective exudates in the neuroepithelium and macular edema in the right eye. Taking her history and the FFA and OCT results into consideration, she was diagnosed with bilateral endogenous endophthalmitis.
CONCLUSIONS: In the present case, multiple white patches and intraretinal hemorrhage at the posterior pole forty-two days after the trauma were not Purtscher\'s retinopathy. It was bilateral endogenous endophthalmitis. The subretinal abcesses that developed secondary to Staphylococcus aureus infection involved the macula causing decreased vision and distortion in the right eye. We concluded that in the case of multiple white retinal patches at the posterior pole in patients after trauma, especially in patients with infectious disease, Purtscher\'s retinopathy is not the only possible diagnosis. Correct diagnosis depends on reevaluation of the lesions by FFA and OCT, laboratory investigation and detailed history.
摘要：
背景：Purtscher的视网膜病变的特征是在严重的头部和胸部创伤后通常发生的后极出现棉绒斑点和视网膜内出血。我们报告了一名严重的胸腹创伤后42天出现多个白色视网膜斑块和视网膜出血的患者，误诊为Purtscher视网膜病变.
方法：一名中年妇女出现在眼科门诊，抱怨在胸腹外伤42天后右眼视力下降和变形。乍一看，她的眼底出现了多个白色视网膜斑块和视网膜出血，我们认为是双侧Purtscher视网膜病变。没有给予她特定的治疗。十天后,右眼的四个白色视网膜斑块与黄斑中的星形硬渗出物和放射状褶皱结合在一起。这与Purtscher视网膜病变的特征不一致。回想起来，我们发现发病时间，形状,白色视网膜斑块的位置不是棉绒斑点。详细的病史显示她因腹部切口感染而患有金黄色葡萄球菌败血症，她接受了静脉注射抗生素治疗。荧光素眼底血管造影（FFA）显示中晚期血管通透性高，荧光渗漏广泛。光学相干断层扫描（OCT）显示，右眼的神经上皮和黄斑水肿具有高度反射性。考虑到她的历史以及FFA和OCT的结果，她被诊断为双侧内源性眼内炎.
结论：在目前的情况下，创伤后42天的多个白色斑块和后极的视网膜内出血不是Purtscher视网膜病变。是双侧内源性眼内炎。金黄色葡萄球菌感染继发的视网膜下凹陷涉及黄斑，导致右眼视力下降和变形。我们得出的结论是，在创伤后患者后极出现多个白色视网膜斑块的情况下，尤其是传染病患者，Purtscher的视网膜病变并不是唯一可能的诊断。正确的诊断取决于FFA和OCT对病变的重新评估，实验室调查和详细的历史。
方法：一名中年妇女出现在眼科门诊，抱怨在胸腹外伤42天后右眼视力下降和变形。乍一看，她的眼底出现了多个白色视网膜斑块和视网膜出血，我们认为是双侧Purtscher视网膜病变。没有给予她特定的治疗。十天后,右眼的四个白色视网膜斑块与黄斑中的星形硬渗出物和放射状褶皱结合在一起。这与Purtscher视网膜病变的特征不一致。回想起来，我们发现发病时间，形状,白色视网膜斑块的位置不是棉绒斑点。详细的病史显示她因腹部切口感染而患有金黄色葡萄球菌败血症，她接受了静脉注射抗生素治疗。荧光素眼底血管造影（FFA）显示中晚期血管通透性高，荧光渗漏广泛。光学相干断层扫描（OCT）显示，右眼的神经上皮和黄斑水肿具有高度反射性。考虑到她的历史以及FFA和OCT的结果，她被诊断为双侧内源性眼内炎.
结论：在目前的情况下，创伤后42天的多个白色斑块和后极的视网膜内出血不是Purtscher视网膜病变。是双侧内源性眼内炎。金黄色葡萄球菌感染继发的视网膜下凹陷涉及黄斑，导致右眼视力下降和变形。我们得出的结论是，在创伤后患者后极出现多个白色视网膜斑块的情况下，尤其是传染病患者，Purtscher的视网膜病变并不是唯一可能的诊断。正确的诊断取决于FFA和OCT对病变的重新评估，实验室调查和详细的历史。
