MULTIPLE ORGAN DYSFUNCTION SYNDROME AND DISSEMINATED INTRAVASCULAR COAGULATION CAUSING EXTENSIVE MULTIPLE AMALRIC TRIANGULAR CHOROIDAL INFARCTIONS

Purpose: To present a case of extensive bilateral choroidal infarctions from multiple organ dysfunction syndrome and disseminated intravascular coagulation.

Methods: A retrospective case report. The medical and imaging records, including fundus photography, optical coherence tomography, fluorescein angiography, and visual fields, were reviewed.

Patient: A 49-year-old woman presented after a failed suicidal attempt from drug overdose. The patient was subsequently intubated for acute hypoxic respiratory failure with presumed septic shock from aspiration pneumonia while requiring exogenous adrenergic support. Her hospital course was further complicated by development of multiple organ dysfunction syndrome and disseminated intravascular coagulation. The patient complained of blurry vision in both eyes after regaining consciousness.

Results: Fundus photography showed bilateral dot-blot hemorrhages and cotton wool spots followed by multiple areas of triangular granular pigmentation, consistent with choroidal infarcts. Fluorescein angiography revealed delayed patchy filling, followed by late staining. Optical coherence tomography showed diffuse thinning of the choroid with overlying retina pigment epithelium atrophy. Goldmann visual field displayed discrete areas of visual field deficits. At the most recent visit, the best-corrected final visual acuity remained 20/100 in the right eye and 20/30 in the left eye.

Conclusion: Disseminated intravascular coagulation has been associated with choroidal infarcts. We present a case of extensive bilateral choroidal infarction in a patient with combined disseminated intravascular coagulation and multiple organ dysfunction syndrome consistent with Amalric choroidal triangular sign.