{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:02:44Z","timestamp":1790665364989,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T00:00:00Z","timestamp":1729209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003819","name":"Natural Science Foundation of Hubei Province","doi-asserted-by":"publisher","award":["WJ2023M083"],"award-info":[{"award-number":["WJ2023M083"]}],"id":[{"id":"10.13039\/501100003819","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003819","name":"Natural Science Foundation of Hubei Province","doi-asserted-by":"publisher","award":["2023AFB214"],"award-info":[{"award-number":["2023AFB214"]}],"id":[{"id":"10.13039\/501100003819","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Purtscher-like retinopathy (PLR) is a rare retinal microangiopathy with unclear pathogenesis. Paracentral acute middle maculopathy (PAMM) is an optical coherence tomography (OCT) sign proposed in recent years, which is characterized by infarction of the middle layer of the retina. This article reported a rare case of PRL and PAMM probably related to improper antihypertensive drug use in a middle-aged male.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A 49-year-old man presented with a complaint of sudden-onset vision loss and paracentral scotomas in the right eye for approximately 1\u2009week. At presentation, the best-corrected visual acuity (BCVA) was 20\/63 OD and 20\/20 OS. Fundus examination showed multiple cotton-wool spots and Purtscher flecken in the posterior segment of the right eye. OCT revealed hyper-reflectivities in the inner nuclear layer (INL), consistent with PAMM. En face OCT showed PAMM\u2019s characteristic \u201cfern-like\u201d perivenular changes. Fluorescein angiography demonstrated prolonged arm-to-retina time, delayed artery and venous filling, and hypofluorescence corresponding to cotton-wool spots. Examinations of the left eye were unremarkable. Many imaging and laboratory tests were performed to detect the possible cause of PLR and PAMM, but no possible explanation was found except improper antihypertensive drug use. The patient was recommended to stop his antihypertensive medication, and prescribed other systemic medicines, including oral prednisolone (40\u2009mg q.d. with gradual tapering), oral cobalamin (0.5\u2009mg\u2009t.i.d.), and subcutaneous injections of compound anisodine (2.0\u2009mL q.d.) beside the superficial temporal artery. Two weeks after onset, his BCVA improved to 20\/25 in the right eye. During follow-ups, his BCVA recovered to 20\/20, accompanied by the regression of fundus lesions. The patient reported no treatment-related adverse effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first reported case of PLR and PAMM following improper antihypertensive drug use. Our report expands our understanding of the etiology and pathophysiology of PLR and PAMM. We also stress the importance of proper application of medications in clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1394614","type":"journal-article","created":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T04:46:15Z","timestamp":1729226775000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Purtscher-like retinopathy and paracentral acute middle maculopathy associated with improper antihypertensive drug use: a case report"],"prefix":"10.3389","volume":"11","author":[{"given":"Yang","family":"Meng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulla","family":"Sawut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miao","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liwei","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuohuizi","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changzheng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1111\/j.1755-3768.1953.tb07662.x","article-title":"Optic atrophy and retinal changes following thoracic trauma; survey of the relationship between traumatic retinal angiopathy (Purtscher), traumatic asphyxia and fat embolism and report of a case","volume":"31","author":"Kehler","year":"1953","journal-title":"Acta Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.survophthal.2005.12.003","article-title":"Purtscher's and Purtscher-like retinopathies: a review","volume":"51","author":"Agrawal","year":"2006","journal-title":"Surv Ophthalmol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.1136\/bjo.2007.117408","article-title":"Purtscher's retinopathy: epidemiology, clinical features and outcome","volume":"91","author":"Agrawal","year":"2007","journal-title":"Br J Ophthalmol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/eye.2012.222","article-title":"Systematic review of Purtscher's and Purtscher-like retinopathies","volume":"27","author":"Miguel","year":"2013","journal-title":"Eye (Lond)"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1093\/qjmed\/hcad204","article-title":"Purtscher-like retinopathy in systemic lupus erythematosus: clinical features, risk factors and prognosis","volume":"116","author":"Meng","year":"2023","journal-title":"QJM"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1016\/j.ophtha.2022.11.011","article-title":"HELLP syndrome-associated Purtscher-like retinopathy","volume":"130","author":"Tsui","year":"2023","journal-title":"Ophthalmology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/j.pan.2022.01.005","article-title":"Acute pancreatitis presenting as Purtscher-like retinopathy","volume":"22","author":"Narang","year":"2022","journal-title":"Pancreatology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/1471-2415-13-36","article-title":"Purtscher-like retinopathy associated with dermatomyositis","volume":"13","author":"Yan","year":"2013","journal-title":"BMC Ophthalmol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e214979","DOI":"10.1001\/jamaophthalmol.2021.4979","article-title":"Bilateral Purtscher-like retinopathy associated with SARS-CoV-2 infection","volume":"140","author":"Pastore","year":"2022","journal-title":"JAMA Ophthalmol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1186\/s12886-023-03186-8","article-title":"Purtscher-like retinopathy and paracentral acute middle maculopathy following breast filler injection","volume":"23","author":"Pee","year":"2023","journal-title":"BMC Ophthalmol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1186\/s12886-023-03176-w","article-title":"Central retinal artery occlusion without cherry-red spots","volume":"23","author":"Fan","year":"2023","journal-title":"BMC Ophthalmol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"100884","DOI":"10.1016\/j.preteyeres.2020.100884","article-title":"Paracentral acute middle maculopathy and the organization of the retinal capillary plexuses","volume":"81","author":"Scharf","year":"2021","journal-title":"Prog Retin Eye Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"l5310","DOI":"10.1136\/bmj.l5310","article-title":"Hypertension in adults: summary of updated NICE guidance","volume":"367","author":"Boffa","year":"2019","journal-title":"BMJ"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1161\/HYPERTENSIONAHA.120.15026","article-title":"2020 International Society of Hypertension Global Hypertension Practice Guidelines","volume":"75","author":"Unger","year":"2020","journal-title":"Hypertension"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1136\/bjo.73.8.677","article-title":"Purtscher's retinopathy and fat embolism","volume":"73","author":"Roden","year":"1989","journal-title":"Br J Ophthalmol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/s0161-6420(85)34023-x","article-title":"Retinal lesions following long bone fractures","volume":"92","author":"Chuang","year":"1985","journal-title":"Ophthalmology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1164\/rccm.201205-0881IM","article-title":"Fat embolism syndrome with Purtscher's retinopathy","volume":"187","author":"Scotton","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1177\/112067210301300412","article-title":"Unilateral Purtscher-like retinopathy after weight-lifting","volume":"13","author":"Kocak","year":"2003","journal-title":"Eur J Ophthalmol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1016\/s0002-9394(99)00204-4","article-title":"Purtscher-like retinopathy associated with pancreatic adenocarcinoma","volume":"128","author":"Tabandeh","year":"1999","journal-title":"Am J Ophthalmol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1016\/j.ajo.2014.09.001","article-title":"Purtscher-like retinopathy in systemic lupus erythematosus","volume":"158","author":"Wu","year":"2014","journal-title":"Am J Ophthalmol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1080\/09273948.2023.2192277","article-title":"Purtscher-like retinopathy in a patient of atopic dermatitis associated with Dupilumab use: a case report","volume":"32","author":"Cheng","year":"2024","journal-title":"Ocul Immunol Inflamm"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1001\/archopht.118.5.726","article-title":"Purtscher retinopathy and necrotizing vasculitis with gemcitabine therapy","volume":"118","author":"Banach","year":"2000","journal-title":"Arch Ophthalmol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"475","DOI":"10.3109\/09273948.2012.714441","article-title":"Purtscher-like retinopathy related to drug-induced hypersensitivity syndrome","volume":"20","author":"Coban-Karatas","year":"2012","journal-title":"Ocul Immunol Inflamm"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1002\/ajh.20845","article-title":"Purtscher-like retinopathy as an initial presentation of a thrombotic microangiopathy associated with antineoplastic therapy","volume":"82","author":"Parc","year":"2007","journal-title":"Am J Hematol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e79","DOI":"10.1111\/jdv.19439","article-title":"Purtscher-like retinopathy after hyaluronic filler injection for facial augmentation","volume":"38","author":"Serkies-Minuth","year":"2024","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"464","DOI":"10.4103\/0301-4738.187679","article-title":"Purtscher-like retinopathy: a rare complication of peribulbar anesthesia","volume":"64","author":"Narendran","year":"2016","journal-title":"Indian J Ophthalmol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1016\/s0002-9394(14)70917-1","article-title":"Purtscher-like retinopathy after uncomplicated administration of retrobulbar anesthesia","volume":"124","author":"Blodi","year":"1997","journal-title":"Am J Ophthalmol"},{"key":"ref28","first-page":"231","article-title":"The mystery of cotton-wool spots - a review of recent and historical descriptions","volume":"13","author":"Schmidt","year":"2008","journal-title":"Eur J Med Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2583","DOI":"10.1007\/s00417-020-04826-1","article-title":"Paracentral acute middle maculopathy-review of the literature","volume":"258","author":"Moura-Coelho","year":"2020","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/qjmed\/hcac249","article-title":"Purtscher-like retinopathy in systemic lupus erythematosus","volume":"116","author":"Ganne","year":"2023","journal-title":"QJM"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3710","DOI":"10.4103\/ijo.IJO_1486_22","article-title":"Unilateral Purtscher-like retinopathy post-COVID-19","volume":"70","author":"Shroff","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e03633","DOI":"10.1002\/ccr3.3633","article-title":"Unilateral Purtscher-like retinopathy as the presenting feature of a case with spontaneous carotid artery dissection","volume":"9","author":"Ipek","year":"2021","journal-title":"Clin Case Reports"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1016\/j.sjopt.2017.05.009","article-title":"Purtscher-like retinopathy - a rare complication of acute myocardial infarction and a review of the literature","volume":"31","author":"Ang","year":"2017","journal-title":"Saudi J Ophthalmol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1394614\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T04:46:17Z","timestamp":1729226777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1394614\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,18]]},"references-count":33,"alternative-id":["10.3389\/fmed.2024.1394614"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1394614","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,18]]},"article-number":"1394614"}}