Retinopathy in a patient with thrombotic thrombocytopenic purpura complicated by polymyositis

Background: Cotton wool spots are known to be a complication in patients wi th thrombotic thrombocytopenic purpura or with polymyositis. Case: A 53-year-old woman developed numerous cotton wool spots around the o ptic disc of both eyes. Observations: Fluorescein angiography disclosed capillary obstruction and m icroaneurysms in the early phase, followed by dye leakage in the late phase . Systemically, she showed fever, hemolytic anemia, fragmented red blood ce lls, thrombocytopenia, proximal muscle weakness, and elevation of serum mus cle enzymes. This led to a diagnosis of thrombotic thrombocytopenic purpura complicated by polymyositis. Conclusion: We believe that this is the first case of thrombotic thrombocyt openic purpura complicated by polymyositis to develop cotton wool spots. Jp n J Ophthalmol 2000;44:161-164 (C) 2000 Japanese Ophthalmological Society.