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Case Report
 
Bilateral exudative multifocal retinal detachment: An unusual presentation of accelerated hypertension with obstructive uropathy
G Nageswar Rao1, Suresh Chandra Dash2, Gayatri Kanungo1, Arttatrana Pal3
1Department of Ophthalmology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India.
2Department of Nephrology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India.
3School of Biotechnology, KIIT University, Bhubaneswar, India.

doi:10.5348/ijcri-2011-12-74-CR-4

Address correspondence to:
Arttatrana Pal
Assistant Professor, Molecular biology Lab
School of Biotechnology, KIIT University
Bhubaneswar 751024
India
Phone: +91-674-2725349
Fax: +91-674-2725732
Email: arttatrana@yahoo.com

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How to cite this article:
Rao GN, Dash SC, Kanungo G, Pal A. Bilateral exudative multifocal retinal detachment: An unusual presentation of accelerated hypertension with obstructive uropathy. International Journal of Case Reports and Images 2011;2(12):15-18.


Abstract
Introduction: We report a case of accelerated hypertension with obstructive uropathy presenting with four days history of headache and profound loss of vision due to exudative retinal detachment, macular ischemia and bilateral hypertensive choroidopathy in young adult.
Case Report: A 27-yr-old male presented with bilateral vision loss. A detailed ocular examination, fundus fluorescein angiography, abdominal ultra sound, cystoscopy, brain CT scan, and laboratory examinations were carried out. Physical examination was notable for a high blood pressure and the visual acuity was present in both eyes. Visual acuity was noted by hand movement and counting fingers at one meter distance in right eye and left eye respectively. Further examination revealed signs of intense headache, vomiting, irritability, and blood pressure of 220/130 mm of Hg. Fundoscopy showed bilateral arteriolar narrowing, retinal hemorrhages, cotton wool exudates, and bullous exudative retinal detachments. Fundus fluorescein angiography revealed macular ischemia and pinpoint leaks. His urinary bladder was distended and Cystoscopy discovered high bladder neck and bladder neck stenosis causing obstruction. Ultrasonography showed dilated ureters suggestive of obstructive uropathy causing chronic interstitial nephropathy and chronic renal failure stage III leading to hypertension. Treatment with antihypertensive therapy over the next four months resulted in improvement in systemic blood pressure and subsided retinal detachment. Subsequently, the high bladder neck obstruction was relieved by appropriate urologic intervention.
Conclusion: This case report highlights the clinical presentation of accelerated hypertension with obstructive uropathy which is rare and the importance for ophthalmologists in first detecting the accelerated hypertension which led to successful recovery with treatment of antihypertensives.

Key Words: Accelerated hypertension, Exudative retinal detachment, Macular ischemia, Obstructive uropathy.

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Author Contributions:
G Nageswar Rao - Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Suresh Chandra Dash - Acquisition of data, Analysis and interpretation of data, Revising the article critically for important intellectual content, Final approval of the version to be published
Gayatri Kanungo - Acquisition of data, Analysis of data, Revising the article critically for important intellectual content, Final approval of the version to be published
Arttatrana Pal - Conception and design, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of submission:
The corresponding author is the guarantor of submission.
Source of support:
None
Conflict of interest:
Authors declare no conflict of interest.
Copyright:
© G Nageswar Rao et al. 2011; This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see www.ijcasereportsandimages.com /copyright-policy.php for more information.) et. al. 2011; This article is distributed the terms of Creative Commons attribution 3.0 License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)