Retinopathy in a patient with thrombotic thrombocytopenic purpura complicated by polymyositis

Background: Cotton wool spots are known to be a complication in patients with thrombotic thrombocytopenic purpura or with polymyositis.Case: A 53-year-old woman developed numerous cotton wool spots around the optic disc of both eyes.Observations: Fluorescein angiography disclosed capillary obstruction and microaneurysms in the early phase, followed by dye leakage in the late phase. Systemically, she showed fever, hemolytic anemia, fragmented red blood cells, thrombocytopenia, proximal muscle weakness, and elevation of serum muscle enzymes. This led to a diagnosis of thrombotic thrombocytopenic purpura complicated by polymyositis.Conclusion: We believe that this is the first case of thrombotic thrombocytopenic purpura complicated by polymyositis to develop cotton wool spots. Copyright (C) 2000 Japanese Ophthalmological Society.