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Purtscher-like retinopathy is an uncommon condition with features similar to Purtscher retinopathy but have non-traumatic causes. Several pathogenic mechanisms have been put forth with differing views on treatment options. We describe for the first time, a case of Purtscher-like retinopathy which developed following a myocardial infarct and a transient ischemic attack. We present a review of the literature on this condition, describing the various clinical presentations, investigation findings, treatment options and prognosis.

BackgroundAntibiotic-resistant bacteria are spread through selective pressure from the use of broad-spectrum empirical therapies, mobile genetic elements that pass resistance genes between species, and the inability to rapidly and appropriately respond to their presence. Resistance gene identification is often performed with post culture molecular diagnostic tests. The T2Resistance Panel, which detects methicillin resistance genes mecA/C; vancomycin resistance genes vanA/B; carbapenemases blaKPC, blaOXA-48,blaNDM, blaVIM, and blaIMP; AmpC β-lactamases blaCMY and blaDHA; and extended-spectrum β-lactamases blaCTX-M directly from patient blood samples, is based on T2 magnetic resonance (T2MR), an FDA-cleared technology with demonstrated high sensitivity and specificity for culture-independent bacterial and fungal species identification. Here we report the clinical performance of T2MR detection of resistance genes directly from patient blood samples.MethodsPatients with a clinical diagnosis of sepsis and an order for blood culture (BC) were enrolled in the study at two sites. BCs were managed using standard procedures and MALDI-TOF for species identification. Resistance testing with the T2MR assay was performed on a direct patient draw and compared with diagnostic test results from concurrent BC specimen and BC specimen taken at other points in time. The potential impact on therapy was evaluated through patient chart review.ResultsT2MR detected the same resistance genes as detected by post culture diagnostics in 100% of samples from concurrent blood draws. Discordant results occurred when T2MR was taken ≥48 hours after BC for patients on antimicrobial therapy. The average time to positive result was 5.9 hours with T2MR vs. 30.6 hours with post-culture molecular testing.ConclusionThe T2Resistance Panel detected antibiotic resistance genes in clinical samples and displayed agreement with post culture genetic testing. T2MR results were achieved faster than culture-dependent diagnostic testing results and may allow for an earlier change from empiric to directed therapy. The use of culture-independent diagnostics like T2MR could enable a quicker response to antibiotic-resistant organisms for individual patients and developing outbreaks.Disclosures All authors: No reported disclosures.

A previously healthy 48-year-old Chinese woman presented with a one-week history of redness, blurred vision and discomfort in both eyes. She also had a frontal headache, and tinnitus and hearing loss in both ears. There was no history of head injury.The patient was alert and oriented. She had nuchal rigidity and a low-grade fever (temperature 37.6°C). Examination of the cranial nerves gave normal results, and there were no cerebellar or long tract motor or sensory signs. There was no rash or lymphadenopathy.The patient's visual acuity, according to a Snellen chart, was 20/30 in each eye. Both pupils had normal direct and consensual light reflexes; visual field, colour vision and the intraocular pressure in each eye were within normal limits. Slit-lamp biomicroscopy of the anterior ocular segment showed mild conjunctival injection and anterior uveitis without hypopyon. Proptosis and orbital bruit were absent. There were no external changes in the ears, and the tympanic membranes in both ears were normal.A complete blood count and erythrocyte sedimentation rate were within normal limits. Lumbar puncture showed clear cerebrospinal fluid and an opening pressure of 16 (normal 10-20) cm water. Analysis of the cerebrospinal fluid showed 185 leukocytes/mm 3 (100% lymphocytes), a protein concentration of 0.2 (normal 0.1-0.5) g/L and a glucose level of 4.0 (normal 2.2-4.2) mmol/L. No micro-organisms were identified in a Gram stain and fungal smear. Magnetic resonance imaging of the head without contrast showed no abnormalities. What is the next step?Which of the following would be the least appropriate next step? a. Administer broad-spectrum intravenous antibiotics without delay. b. Administer systemic steroids. c. Refer the patient to an ophthalmologist for fundal fluorescein angiography. d. Refer the patient to an otolaryngologist for audiometry.The answer is (b). Systemic steroids should not be administered before an underlying infection, which could be the cause of this clinical presentation, has been excluded. In a patient with clinical and laboratory features of meningitis, it is important to administer empirical broad-spectrum antibiotics until cerebrospinal microbial cultures return negative results or when clinical judgement supports discontinuing therapy. This patient had clinical features of lymphocytic meningitis and anterior and posterior uveitis, which suggested a uveomeningeal syndrome.The causes of uveomeningeal syndromes include autoimmune, infectious and neoplastic disorders; therefore, a thorough investigative work-up should be done before systemic steroids are given.An ophthalmologic evaluation -including stereoscopic examination of the fundus and fundal fluorescein angiography -can help determine the intraocular extent of uveitic involvement and identify the diagnostic fundal and angiographic markers of some syndromes with uveitis. Early assessment of the type, extent and severity of uveitis by an ophthalmologist is important to ensure timely treatment and prevent adverse effects. Although an otolaryn...