Bilateral obliterating periphlebitis in Gitelman syndrome

Purpose Gitelman syndrome (GS) is a rare inherited defect in the distal tubule of the kidneys, characterized by a remarkable reduction of salt transportation. Consequently, GS patients present renal salt wasting, low blood pressure, hypochloremia, hypokalemia, metabolic alkalosis and hypercalciuria. Some patients are completely asymptomatic but others show transient periods of muscle weakness, tetany, paresthesias, paralysis or cardiac rhythm alterations. Sclerochoroidal calcifications have been reported in GS. Methods A 44 year old female, diagnosed as GS after suffering an acute hypopotassemia episode 2 months before, arrived at the ER complaining of sudden vision diminution in her left eye (LE). She underwent a comprehensive ophthalmic examination and a fluorescein angiography (FA). Results The best‐corrected visual acuity on Snellen chart was RE 10/10 and LE 6/10. Funducopic examination showed a bilateral obliterating periphlebitis with sheathed venous vessels and vitritis in her LE. Blood pressure was 96/63 mm Hg. Blood and urine test showed hypopotassemia (2.6mEq/l) and hypocalciuria, despite of the administration of magnessium, postassium and aspartic acid oral supplements. The FA showed vascular sheathed, venous occlusion, macular edema and peripheral ischemia. The patient received medical treatment including a subtenon injection of triamcinolone, mydriatic and esteroid eye drops and oral prednisone 1mg/Kg per day. After a worsening of her RE BCVA, she showed a slow improvement being the prednisone dose progressively reduced. The vasculitis subsided with persistence of peripheral sclerosed vessels in both eyes. Conclusion GS can be the cause of an acute obliterating periphlebitis that required high corticosteroid doses to be controlled.