Great mimic: Purtscher’s retinopathy unmasks acute pancreatitis in a patient on peritoneal dialysis

A woman in her late 30s with kidney failure on automated peritoneal dialysis (PD) presented with abdominal pain, cloudy dialysate and hyperkalaemia and was initially treated for presumed PD peritonitis after CT showed a malpositioned catheter. 2 days later she developed sudden bilateral visual loss to counting fingers. Ophthalmic examination revealed features consistent with Purtscher's retinopathy, prompting a broader systemic reassessment. Serum lipase was markedly elevated and repeat contrast CT confirmed acute interstitial pancreatitis. She received supportive management, including laparoscopic PD catheter exchange and temporary haemodialysis, with resolution of abdominal pain and steady improvement in vision by discharge and at follow-up. This case highlights that pancreatitis can masquerade as PD peritonitis in patients with abdominal pain and cloudy effluent and illustrates how ocular findings can redirect diagnosis when clinicians actively guard against anchoring bias.