New diagnosis of diabetes and severe hyperlipidemia at 3 months postpartum presenting as florid diabetic retinopathy and eruptive xanthomas

A 33-year-old woman presented to the Emergency Department at 3 months postpartum with a 2-day history of a partial left sixth cranial nerve palsy, and several weeks' history of bilateral blurred vision and papular skin lesions. Brain imaging and ultrasound of the carotid and vertebral arteries were all normal. Investigations revealed severe hyperlipidemia and a venous blood glucose level of 19.6 mmol/L despite a negative result on a 75-g oral glucose tolerance test at 32 weeks of pregnancy. Fundus photography demonstrated bilateral severe proliferative diabetic retinopathy with lipemia retinalis. The skin lesions were consistent with xanthomas on biopsy. The partial left sixth cranial nerve palsy and the bilateral rapidly progressive diabetic retinopathy were likely secondary to peripheral ischemia from serum hyperviscosity and displacement due to severe hyperlipidemia. The rapid progression of symptoms was likely triggered by a postpartum diet high in saturated fats in the context of presumed genetic predisposition.