HELLP Syndrome-Associated Purtscher-like Retinopathy

A 36-year-old healthy woman underwent emergent Cesarean section due to preeclampsia. She was intubated and transferred to the intensive care unit for airway management and seizure prevention. She developed hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and tested positive for SARS-CoV-2. On extubation 4 days later, she reported bilateral blindness. Neuroimaging was consistent with posterior reversible encephalopathy syndrome. After hospital discharge (2 weeks after loss of vision), her vision was counting fingers in both eyes. Her dilated fundus examination demonstrated macular and peripapillary whitening and hemorrhages, consistent with bilateral Purtscher-like retinopathy (Fig A-B right eye, Fig C-D left eye) (Magnified version of Fig A-D is available online at www.aaojournal.org).