Discussions By Condition: I cannot get a diagnosis.

Blindness and acute pancreatitis in a Cambodian boy.

Posted In: I cannot get a diagnosis. 7 Replies
  • Posted By: Chaiyodsilp
  • February 18, 2008
  • 02:21 PM

A 4 year old Cambodian boy presented at a Hospital in Cambodia with vomiting and unable to eat. Previously he had 3 episode of falling off the chair, the bike and smash his tummy with the table while running. At the hospital he had CT brain done (result-brain swelling), lumbar puncture done (result unobtainable). He was treated as tuberculous meningitis with Ethambutol and Rifampicin and some antihypertensive drug including Captopril. two weeks after that he had convulsion while doctors attempting aspiration of the blood from his temporal area (temporal vein aspiration??). A few days after that he had upper GI bleeding and was tranferred to Thailand where we saw him. At our hospital he was diagnosed as having 1. Acute pancreatitis (with ascites, markedly increase amylase and lypase) 2. Complete Blindness (optic neuritis?) 3. Nutritional defficiency, particularly hypokalemia and hypocalcemia. The CT abdomen was done and revealed two loculation around kidney from which the fluid was aspirated under US guide. The sample was old blood. The ascites fluid was dark brown. The CSF was clear without cell. All the samples (ascites fluid, CSF, retroperitoneal pocket aspiration) were negative for gm stain, AFB stain, culture and sensitivity test. He had intermittent low grade fever and occasionally high blood pressure (upto 190 systolic sometimes)
At this stage he has good conscious and response well to verbal command but completely blind (no light perception) My concern is the blindness. Tumor or other space taking lesion is unlikely because his conscious level is too good. The drug (Ethambutol) is unlikely because it's so sudden. The other concern is whether there is any link between pancreatitis and blindness in this case.
Sant, MD

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7 Replies:

  • A four year old boy with Purtscher's retinopathy
    TerryG 120 Replies
    • February 19, 2008
    • 00:00 PM
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  • What does his funduscopic exam look like?
    Anonymous 42789 Replies
    • February 19, 2008
    • 09:56 PM
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  • His eye grounds were normal both sides.
    Chaiyodsilp 2 Replies
    • February 25, 2008
    • 01:47 PM
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  • I mean there is no cotton-wool spots, no peri-papillary retinal whitening, no pre-retinal and/or retinal hemorrhages no macular edema.
    Chaiyodsilp 2 Replies
    • February 25, 2008
    • 01:54 PM
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  • This is from Archives of Int Med: http://archinte.ama-assn.org/cgi/content/abstract/141/1/134
    aquila 1263 Replies
    • February 25, 2008
    • 07:20 PM
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  • I think Purtscher's retinopathy is supposed to show (bilateral) retinal haemorrhages, cotton wool spots, and optic disc swelling seen on fundoscopy, but maybe this isn't with every case...If you use the "multiple symptom checker" here for "pancreas symptoms" and "blindness", 18 things come up:Bardet-Biedl syndrome, many different typesNorrie DiseaseSepto-optic dysplasiaSjogren'sand Von Hippel Lindau DiseaseThe only thing is that for some of these, the "pancreas symptoms" are diabetes and not pancreatitis, so they may not apply. You might want to look them up and see if any apply.Sorry this isn't much helpGood Luck
    Anonymous 42789 Replies
    • February 26, 2008
    • 05:59 AM
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  • I'll go with Septo-optic dysplasia, hormone deficiency. since re-reading this thread I would say he has always been visually inpaired or very accident prone.
    TerryG 120 Replies
    • February 27, 2008
    • 07:52 AM
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