S3398 Purtscher-Like Retinopathy as an Unusual Initial Manifestation of Acute Pancreatitis in a Postpartum Patient

Introduction: Purtscher-like retinopathy is a rare retinal microangiopathy typically associated with traumatic injuries or systemic conditions with complement activation, including acute and chronic pancreatitis. While most gastrointestinal pathologies present with abdominal symptoms, other symptoms may also give clues. We present a case of Purtscher-like retinopathy as the initial manifestation of acute pancreatitis in a postpartum patient. Case Description/Methods: Thirty-two-year-old woman with a medical history of hypertension, class III obesity (body mass index 40), and iron deficiency anemia presented at 33 weeks of gestation with elevated blood pressure. She was diagnosed with pre-eclampsia, for which she was started on labetalol and underwent an uncomplicated cesarean section. Postoperatively, she experienced mild abdominal pain. On postoperative day 2, she developed bilateral blurred vision and headaches. Computed tomography head was unremarkable, but fundoscopic examination revealed multiple polygonal peripapillary retinal whitening areas (Purtscher flecken), prompting evaluation for systemic etiologies. Given the known association with pancreatitis, a serum lipase level was obtained and found to be elevated. Computed tomography abdomen confirmed acute interstitial pancreatitis. The patient was appropriately treated with intravenous fluids and supportive care. Her symptoms improved, and she was discharged in stable condition with outpatient follow-up. Discussion: Though uncommon, Purtscher-like retinopathy may serve as an important clinical clue for underlying systemic diseases such as acute pancreatitis, especially in patients with vague symptoms or overlapping peripartum complications. The pathogenesis is thought to involve complement activation and leukocyte embolization leading to retinal ischemia. In this case, the initial manifestation of pancreatitis was visual disturbances, which underscores the importance of a multidisciplinary approach in evaluating atypical presentations. Early identification and treatment of pancreatitis is critical to prevent severe complications.