27846860 Visualization

A 20 Age - year Age - old Age previously History healthy History Bengali Personal_background man Sex presented Clinical_event to our hospital Nonbiological_location with anuria Sign_symptom and features of uremic Detailed_description encephalopathy Disease_disorder .
Ten Date days Date prior Date to this presentation, he had experienced severe Severity upper Biological_structure abdominal Biological_structure pain Sign_symptom and vomiting Sign_symptom , and he had been treated Therapeutic_procedure in a primary Nonbiological_location care Nonbiological_location facility Nonbiological_location for having a case of acute Detailed_description pancreatitis Disease_disorder .
His initial Sign_symptom symptoms Sign_symptom improved; however, he gradually became anuric Sign_symptom and disoriented Sign_symptom .
Then he was transferred Clinical_event to our hospital Nonbiological_location for further management.
At presentation Clinical_event to our hospital, he was severely Severity agitated Sign_symptom , restless Sign_symptom , and disoriented Sign_symptom .
He was tachypneic Sign_symptom with acidotic Sign_symptom breath Sign_symptom .
Mild Severity pedal Biological_structure edema Sign_symptom was present; however, his jugular Diagnostic_procedure venous Diagnostic_procedure pressure Diagnostic_procedure was not Lab_value raised Lab_value .
His pulse Diagnostic_procedure was 112 Lab_value beats/minute Lab_value , his blood Diagnostic_procedure pressure Diagnostic_procedure was 140/90 Lab_value mmHg Lab_value , and his body Diagnostic_procedure temperature Diagnostic_procedure was 98 Lab_value °F Lab_value .
Signs of meningeal Biological_structure irritation Sign_symptom were absent, and his plantar Diagnostic_procedure response Diagnostic_procedure was bilaterally Lab_value extensor Lab_value .
His fundus Diagnostic_procedure could Lab_value not Lab_value be Lab_value evaluated Lab_value , and examination Diagnostic_procedure of his other Biological_structure systems Biological_structure was unremarkable Lab_value .
His laboratory Diagnostic_procedure parameters Diagnostic_procedure showed features of renal Disease_disorder dysfunction Disease_disorder ( serum Diagnostic_procedure creatinine Diagnostic_procedure 13 Lab_value mg/dl Lab_value , serum Diagnostic_procedure urea Diagnostic_procedure 293 Lab_value mg/dl Lab_value ), raised Lab_value pancreatic Diagnostic_procedure enzymes Diagnostic_procedure ( serum Diagnostic_procedure amylase Diagnostic_procedure 249 Lab_value U/L Lab_value [reference up to 100 U/L], serum Diagnostic_procedure lipase Diagnostic_procedure 227 Lab_value U/L Lab_value [reference 13–60 U/L), normal Lab_value liver Diagnostic_procedure function Diagnostic_procedure tests ( serum Diagnostic_procedure bilirubin Diagnostic_procedure 0.9 Lab_value mg/dl Lab_value , alanine Diagnostic_procedure aminotransferase Diagnostic_procedure 38 Lab_value U/L Lab_value , aspartate Diagnostic_procedure aminotransferase Diagnostic_procedure 35 Lab_value U/L Lab_value , alkaline Diagnostic_procedure phosphatase Diagnostic_procedure 122 Lab_value U/L Lab_value , serum Diagnostic_procedure albumin Diagnostic_procedure 37 Lab_value g/L Lab_value ), normal Lab_value potassium Diagnostic_procedure ( 5.1 Lab_value mmol/L Lab_value ), normal Lab_value bicarbonate Diagnostic_procedure ( 19 Lab_value mmol/L Lab_value ), and normal Lab_value triglycerides Diagnostic_procedure ( 173 Lab_value mg/dl Lab_value ).
His serological Diagnostic_procedure markers Diagnostic_procedure , including antinuclear Diagnostic_procedure antibodies Diagnostic_procedure , cytoplasmic Diagnostic_procedure antineutrophil Diagnostic_procedure cytoplasmic Diagnostic_procedure antibodies Diagnostic_procedure , perinuclear Diagnostic_procedure antineutrophil Diagnostic_procedure cytoplasmic Diagnostic_procedure antibodies Diagnostic_procedure , C3 Diagnostic_procedure , and C4 Diagnostic_procedure , were within Lab_value normal Lab_value limits Lab_value .
An ultrasonogram Diagnostic_procedure of his whole abdomen Biological_structure was unremarkable Lab_value , but non Detailed_description - contrast Detailed_description - enhanced Detailed_description computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) findings were suggestive of acute Detailed_description pancreatitis Disease_disorder (Fig.1).
His kidneys Diagnostic_procedure were unremarkable Lab_value , however.
The patient was managed as having a case of AKI Disease_disorder and acute Detailed_description pancreatitis Disease_disorder .
Urgent Detailed_description hemodialysis Therapeutic_procedure was initiated.
After he had received two Detailed_description sessions Detailed_description of hemodialysis Therapeutic_procedure , his level Diagnostic_procedure of Diagnostic_procedure consciousness Diagnostic_procedure improved Lab_value , but he complained of profound Severity visual Disease_disorder loss Disease_disorder .
An assessment revealed only perception Sign_symptom of Sign_symptom light Sign_symptom .
A funduscopic Diagnostic_procedure examination Diagnostic_procedure showed retinal Sign_symptom whitening Sign_symptom and extensive Severity cotton Sign_symptom wool Sign_symptom exudates as well as Purtscher’s Sign_symptom flecken Sign_symptom (Fig.2) compatible with Purtscher’s Disease_disorder retinopathy Disease_disorder .
High Dosage - dose Dosage parenteral Administration methylprednisolone Medication ( 1 Dosage g Dosage intravenously Administration once Dosage daily Dosage for 3 Duration days Duration ) was administered.
For evaluation Diagnostic_procedure of Diagnostic_procedure renal Diagnostic_procedure dysfunction Diagnostic_procedure , a renal Biological_structure biopsy Diagnostic_procedure was done; the histopathological Diagnostic_procedure findings Diagnostic_procedure were compatible with renal Disease_disorder cortical Disease_disorder necrosis Disease_disorder (Fig.3).
The patient denied History substance History abuse History or History alcohol History ingestion History .
He did History not History consume History any History nephrotoxic History drugs History or History herbal History products History in History the History recent History past History .
No History history History suggesting History connective History tissue History diseases History was History available History , nor did he have a history of hypotension Sign_symptom throughout the course of his current illness.
The patient was finally diagnosed with acute Detailed_description pancreatitis Disease_disorder complicated with renal Disease_disorder cortical Disease_disorder necrosis Disease_disorder leading to AKI Disease_disorder and Purtscher’s Disease_disorder retinopathy Disease_disorder leading to complete Severity bilateral Detailed_description blindness Disease_disorder .
He died Outcome 16 Date months Date after Date his initial presentation as a result of a recurrent Detailed_description attack of acute Detailed_description pancreatitis Disease_disorder .
Before that, he had been undergoing maintenance Detailed_description hemodialysis Therapeutic_procedure ; however, his renal Diagnostic_procedure function Diagnostic_procedure did Lab_value not Lab_value recover Lab_value , though his vision Diagnostic_procedure was improved Lab_value to finger Diagnostic_procedure - counting Diagnostic_procedure at 2 Lab_value feet Lab_value .