Purtscher-like retinopathy as a presenting ocular manifestation of biopsy-proven giant cell arteritis: A case report.

Purtscher-like retinopathy is a rare retinal microangiopathy characterised by sudden visual loss, cotton wool spots, retinal whitening and variable retinal haemorrhage in the absence of trauma. Giant cell arteritis is an ophthalmic emergency that usually presents with ischaemic optic neuropathy or retinal arterial occlusion or choroidal ischaemia; however, in very rare cases, it may mimic Purtscher-like retinopathy. We report the case of a 60-year-old man who presented with sudden painless vision loss in the left eye. Fundus examination showed marked optic disc oedema, cotton wool spots, arterial narrowing and multiple discrete white retinal lesions in the posterior pole. Optical coherence tomography demonstrated inner retinal thickening and hyperreflectivity, whereas fluorescein angiography revealed markedly delayed retinal perfusion, capillary nonperfusion, branch retinal arterial occlusion, nasal/inferotemporal choroidal hypoperfusion and optic disc hyperfluorescence. Her erythrocyte sedimentation rate was 52 mm/h, and temporal artery biopsy confirmed giant cell arteritis. The patient received intravenous methylprednisolone followed by oral corticosteroids. Visual acuity did not improve over the first week, although optic disc oedema decreased. This case should not be interpreted as isolated or pure Purtscher-like retinopathy; rather, it represents Purtscher-like retinal findings occurring within a broader giant cell arteritis-related retinal and choroidal ischaemic process. The report broadens the spectrum of ocular presentations of giant cell arteritis and highlights the need to consider occult giant cell arteritis in the differential diagnosis of older patients with sudden painless visual loss and retinal ischaemic signs suggestive of Purtscher-like retinopathy.