A Case Report of Isolated Hypertensive Choroidopathy in a Context of Renal Failure due to Suspected Prolonged High-Protein Diet Intake Combined with Anabolic Steroid Use.

Abstract

Introduction: Hypertensive chorioretinopathy develops in a context of acute blood pressure elevation associated with uncontrolled malignant hypertension as an isolated or primary manifestation of systematic disease. However, hypertensive choroidopathy without associated hypertensive retinopathy remains less frequent than manifestation of both combined.

Case presentation: A male in his mid-twenties presented to our emergency ophthalmology department with a 4-day history of progressive, painless bilateral visual loss. He had marked muscular hypertrophy, low body fat, and a history of poorly controlled hypertension with a previous episode of acute kidney injury. Visual acuity was 1/20 (right eye) and 2/10 (left eye). Fundus examination revealed bilateral disc edema, multiple yellowish subretinal lesions consistent with ischemic damage of the retinal pigment epithelium, and bilateral exudative retinal detachment. No definite signs of hypertensive retinopathy were detected. Macular optical coherence tomography showed severe bilateral macular edema with exudative foveal detachment. Stage 3-elevated blood pressure raised suspicion for malignant hypertension. Further evaluation revealed a new episode of acute kidney failure and a history of anabolic steroid use with excessive protein intake. Malignant hypertension was diagnosed, and emergency dialysis and antihypertensive therapy were initiated. Visual symptoms improved and exudative retinal detachments markedly resolved within 14 days, but the yellowish subretinal lesions persisted several days after blood pressure normalization. The patient currently awaits kidney transplantation for non-biopsy-proven hypertensive nephrosclerosis-related end-stage renal disease.

Conclusion: Isolated hypertensive choroidopathy could be a primary manifestation of renal failure among individuals with an abnormally high-protein diet intake in a context of anabolic steroid use.