Case 2-2008: A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

摘要

Dr. EspemnceA, Schaefer (Medicine): A 38-year-old woman was admitted to the hospital, because of blurred vision and shortness of breath, 2 weeks after a cesarean section had been performed because of preeclampsia during pregnancy.The patient had been well until approximately 6 weeks before admission, at approximately 22 weeks' gestation, when a diagnosis of preeclampsia was made at another hospital. Seventeen days before admission, at approximately 25 weeks' gestation, acute shortness of breath and chest tightness developed, and she was admitted to the other hospital. The blood pressure was 175/105 mm Hg. Aminotransferase and uric acid levels were normal; the results of other laboratory tests are shown in Tables 1 and 2. A chest radiograph revealed increased interstitial markings and perihilar haziness, findings that were consistent with pulmonary edema. A cesarean section was performed on the third hospital day. Pathological examination of the placenta revealed an immature placenta, weighing 130 g, with infarcts, a triyessel cord, and chronic active chorionitis. The systolic blood pressure improved after the cesarean section and treatment with nifedipine and atenolol. The day after delivery, blurred vision and scotomata developed. The next day, the patient was awakened from sleep by occipital and left-temporal headaches,. On examination of the eyes in an undilated state, an ophthalmologist found uveitis and placoid lesions in the cho-roid. Treatment with enoxaparin was begun. The patient was discharged on the 11th hospital day, with a plan for follow-up with an ophthalmologist.