UNASSIGNED: A 27-year-old previously healthy man presented with headaches and bilateral blurred vision for 2 weeks. The visual acuity was 20/30-1 and 20/60-2 in the right eye and left eye, respectively. A fundus examination revealed Roth spots, diffuse multilayer retinal hemorrhages in the macula and periphery, and tortuous vessels in both eyes. Optical coherence tomography showed a disrupted foveal contour from intraretinal fluid and hemorrhage in both eyes. Fluorescein angiography demonstrated dilated and tortuous vessels with scattered blocking defects from hemorrhages.
UNASSIGNED: A workup revealed warm hemolytic anemia with severe thrombocytopenia consistent with the diagnosis of Evans syndrome.
UNASSIGNED: Evans syndrome is a rare blood dyscrasia that can first present as subacute vision loss and should be added to the differential of diffuse bilateral retinal hemorrhages spanning a multitude of retinal layers.
■一名27岁健康男子出现头痛和双侧视力模糊2周。右眼和左眼的视力分别为20/30-1和20/60-2,分别。眼底检查发现罗斯斑,黄斑和周边弥漫性多层视网膜出血,两眼都有曲折的血管。光学相干断层扫描显示,视网膜内液和双眼出血导致的中央凹轮廓破裂。荧光血管造影显示血管扩张和曲折,出血有分散的阻塞缺陷。
■一项检查显示热溶血性贫血伴严重血小板减少症,与Evans综合征的诊断一致。
■埃文斯综合征是一种罕见的血液发育不良,可首先表现为亚急性视力丧失,应与跨越多个视网膜层的弥漫性双侧视网膜出血的差异相加。