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A 20-year-old male with uncontrolled hypertension secondary to cytoplasmic-staining
antineutrophil cytoplasmic antibody (C-ANCA)–associated renal vasculitis presented
with 3 weeks of gradual blurred vision bilaterally. His blood pressure (189/127 mm
Hg at presentation) had reached 200/130 mm Hg in the preceding weeks. Visual acuity
was 20/70 OD and 20/60 OS. Fundus examination revealed subtle bilateral optic disc
edema, abundant acute Elschnig spots, flame-shaped hemorrhages, and inferior exudative
retinal detachments (Fig. 1A, B). Fluorescein angiography showed delayed and patchy choroidal filling with widespread
hyperfluorescent spots (Fig. 1C, D). This case demonstrates the appearance of acute fundus findings resulting from choroidal
infarction and the presence of exudative retinal detachments, indicating blood–retinal
barrier impairment. The patient was counselled on blood pressure control to prevent
further vision loss.
Fig. 1Colour fundus photographs of the right eye (A) and left eye (B) showing subtle bilateral
optic disc edema, abundant acute Elschnig spots, flame-shaped hemorrhages, and inferior
exudative retinal detachments. Fluorescein angiography of the right eye (C) and left
eye (D) showing patchy choroidal filling and widespread focal areas of hyperfluorescence.
