Purtscher-like retinopathy as the manifestation of adult Still’s disease

Adult Still's disease (ASD) is a rare systemic inflammatory disorder for which ocular manifestations have rarely been described. We report a case of 38-year-old Brazilian woman with Purtscher-like retinopathy as a manifestation of ASD. She was diagnosed with Purtscher-like retinopathy based on fundoscopic findings, which revealed vasculitis with diffuse and bilateral perimacular cotton-wool exudates. She also presented with fever, arthritis, weight loss, and a diffuse cutaneous rash. Considering the severity of the retinopathy, she was initially treated with methylprednisolone pulse therapy and oral methotrexate, and later with infliximab, with the treatment changing due to partial recovery of vision loss. Purtscher-like retinopathy is a poor prognostic factor for ASD, as it can lead to permanent visual damage. Thus, early and aggressive immunosuppressive therapy is mandatory.