In the course of hospitalization, gradual decrease in triglyceride levels was detected, and visual acuity was recovered to almost 100% of its previous situation. During the stay, the patient remained stable and oligosymptomatic with serum therapy and analgesic, dietary, antidiabetic (insulin glulisine and rapid insulin) and lipid-lowering treatment (atorvastatin 40 mg/24 hours, Fenofibrate 200 mg/12 hours). The patient was hospitalized with a diagnosis of lipemia retinalis, acute pancreatitis secondary to severe hypertriglyceridemia, and incipient diabetes mellitus. Retinography of the left eye: whitening of all retinal vessels on a salmon-like fundus, compatible with severe lipemia retinalis (Vinger and Sachs Grade III). Fundoscopy showed creamy retinal vessels with opalescent whitish appearance over a salmon-colored fundus, without associated papilledema, compatible with lipemia retinalis ( Figures 1 and and2 2). Visual acuity was estimated in right eye (0.8/1) and the left eye (0.5/1). The ophthalmological examination did not show xanthomas or xanthelasmas, and confrontational campimetry and oculomotor cranial nerve examination were normal. The symptom that most concerned the patient was the decrease in visual acuity, in the absence of intraocular pain even with ocular movements. Abdominal ultrasound and cranial and abdominal computerized axial tomography were performed, with normal results, except for some discrete inflammatory changes present in the pancreatic tail, compatible with acute allithiasic pancreatitis. Secondary processing of the sample, after the addition of 1,1,2 Trichlorotrifluoroethane, allowed to obtain the following results: 11,930 mg/dL triglycerides (30-150 mg/dL), 10,268 mg/dL chylomicrons, 1,490 mg/dL cholesterol (150-250 mg/dL), 304 mg/dL glucose (70-110 mg/dL) and 86 U/L amylase (1-100 U/L). An intensely lipemic serum was obtained after blood extraction, in a way that the initial evaluation of biochemical analytical parameters was not achievable. The anamnesis revealed unhealthy dietary habits with frequent intake of carbonated drinks and dairy products. In this occasion, the patient is cared for in our service due to decreased visual acuity, headache and abdominal pain in the previous two weeks. Three years later, the value increased to 1,184 mg/dL, remaining fully asymptomatic with no treatment. The patient had no previous ophthalmological interesting history.Ī routine endocrinology analysis detected hypertriglyceridemia 638 mg/dL (30-150 mg/dL) but the patient refused pharmacological treatment. Six years before being attended in our hospital, he was diagnosed with normal functioning multinodular goiter, cervical Schwannoma and hepatitis C genotype 1b, F1 virus and received no treatment. As a sequel of this treatment, he presented severe hypogonadism and decreased lung capacity. He underwent his father's HLA-incompatible allogeneic transplant, requiring high doses of cyclophosphamide, cytarabine, and total body radiation therapy. As a previous history, the patient suffered from acute myeloid leukemia with diagnosis at the age of 5 years and was treated with high doses of anthracyclines after several recurrences. We present the case of a 40-year-old male patient who came to the emergency department with a 14-day history of visual acuity alteration. The observation of milky-colored retinal vessels on a salmon-colored eye fundus and the inspection of a creamy layer of supernatant in the biochemical tube were essential to determine the diagnosis of hyperchylomicronemia, and perform an early treatment to achieve a prompt complete visual recovery. We present the case of a 40-year-old patient who came to the emergency department because of visual acuity alteration as a guiding symptom. Heyl in 1880 as intraocular lipaemia 4, who depicted salmon color of the retinal arteries and veins in relation to the abnormally high presence of fat in blood serum in contrast to the light color of the fundus oculi.Īlthough the exact epidemiology of lipemia retinalis is still unknown, it is estimated that approximately 23% of patients with severe hypertriglyceridemia may develop this clinical manifestation 1 due to deficiency or saturation of the enzyme lipoprotein lipase (LPL), which causes a sustained accumulation of circulating chylomicrons 2, 5. Initially, peripheral vessels are involved, and central retinal vessels are affected as severity increases 3. This infrequent complication of chylomicron accumulation in retinal vessels 1 is observed when serum triglyceride levels exceed values of 2,000 mg/dL 2 and gives them a white and creamy appearance in ocular fundus examination. Lipemia retinalis is a pathognomonic sign of hyperchylomicronemia.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |