非典型高血壓脈絡膜病變表現與末期腎臟病變關聯之病例報告

From an atypical presentation of hypertensive choroidopathy to the end-stage renal disease in a young man: A case report

目的： 呈現一位健康男性表現高血壓脈絡膜病變之非典型癥兆，並爾後導致末期腎臟病變。病例報告： 一位25歲健康男性因四天內左眼逐步惡化之視力模糊求診。眼底視網膜檢查發現雙眼廣泛性視網膜動脈狹窄、少量火焰狀視網膜出血及視神經盤水腫。此外，於視網膜色素細胞層也表現多顆深圓之黃色斑塊，以及大範圍之積液性視網膜剝離。於住院調查惡性高血壓期兩週內即快速進展為腎衰竭。之後亦即輔以控制血壓至可接受範圍，然而最終仍進展為需終身進行血液透析IRB之末期腎臟病變。結論及重要性： 年輕人之急性血壓升高，眼底脈絡膜病變可能為其重要表徵。而相關之眼底發現更可能於終端器官的損傷有所關聯。唯有即時診斷並立即給予相對應之處置可預防不可逆之器官損傷。

 

Purpose Topresenta case of hypertensive choroidopathy with an atypical presentation on a healthy young man, and the end-stage renal diseaseeventually developed. Case report A 25-year-old man without a significant previous medical history presented to our clinic with progressively worsening blurry vision in the left eye for 4 days.Dilated fundus examination revealed diffuse arteriolar narrowing, arteriovenous nicking, only a few sites of flame-shaped hemorrhage, and disc edema in both eyes. Moreover, multiple deep, round, and yellow patches at the level of retinal pigment epithelium and extensiveexudativeretinal detachment were also found. Rapid progression to renal failure developed within 2 weeks after hospitalized for systemic evaluation ofmalignant hypertension. Even though blood pressure was well controlled thereafter, it progressed to an end-stage renal disease, which required lifelong hemodialysis. Conclusions and Importance In young adults with an acute episode of hypertension, choroidopathy can be the predominant ophthalmic feature. Certain fundoscopic signs may correlate with theend-organ damage to thekidney. Timely diagnosis and immediate referral for treatment of hypertension are critical to prevent irreversible ocular and other end-organdamage.