https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310359/

A case of Bartonella neuroretinitis with macular star diagnosed by clinical, epidemiological, serological, and molecular data: resolution after initiation of antimicrobial therapy

A case of Bartonella neuroretinitis with macular star diagnosed by clinical, epidemiological, serological, and molecular data: resolution after initiation of antimicrobial therapy
Walter de Araujo Eyer-Silva, 1 Letícia Stéfanie Curvello Wutke, 1 Alexandre de Carvalho Mendes Paiva, 1 Guilherme Almeida Rosa da Silva, 1 Fernando Raphael de Almeida Ferry, 1 Dario José Hart Pontes Signorini, 1 Jonathan Gonçalves de Oliveira, 2 and Elba Regina Sampaio Lemos 2
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Abstract
The differential diagnosis of optic neuritis is broad and varied. We report the case of a 24-year-old Brazilian man who presented with five-week history of fever, malaise, myalgia, severe fatigue, tender right preauricular lymphadenopathy, and acute vision blurring associated with right optic disc swelling and exudates in a macular star pattern. His illness developed soon after an infestation of fleas broke out among his cats. Diagnosis of ocular bartonellosis was confirmed by serological and molecular analyses targeting amplification of Bartonella spp. htrA gene. Signs and symptoms only improved after initiation of antimicrobial therapy.

Keywords: Bartonella henselae, Cat scratch disease, Ocular bartonellosis
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INTRODUCTION
The eye is the most commonly affected non-lymphatic site in patients with cat scratch disease (CSD), a zoonosis caused by Bartonella henselae 1 . The first clinical syndrome of what is now known as ocular bartonellosis was described in 1889 by a French neuro-ophthalmologist, Henri Parinaud, in patients with granulomatous follicular conjunctivitis, chronic fever, regional lymphadenopathy, and previous contacts with pets 1 . This syndrome is now known as Parinaud oculoglandular syndrome and ocular bartonellosis is one of its causes. Another clinical syndrome of ocular bartonellosis is neuroretinitis, a form of optic neuropathy characterized by optic disk swelling and eventual development of a partial or complete macular star. It was first described by a German ophthalmologist, Theodor Leber, in 1916 1 . The association of “Leber’s idiopathic stellate neuroretinitis” with CSD was first suggested by Sweeney and Drance in 1970 2 .

Herein we report the case of a Brazilian man who developed acute blurring of vision associated with optic disc swelling and exudates in a macular star pattern soon after an infestation of fleas broke out among his cats. Signs and symptoms remitted only after initiation of antimicrobial therapy.

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CASE REPORT
In late October 2018, a 24-year-old previously healthy male patient from the city of Rio de Janeiro, Brazil, developed a tender right preauricular lymphadenopathy and malaise. In early November 2018, he developed fever, myalgia, headaches, severe fatigue, and enhanced preauricular lymphadenopathy. On November 4, 2018, he suddenly noted blurring of vision in his right eye. There was no pain on ocular movement. He sought medical advice at another facility and was diagnosed with a “probable parotitis.” An otolaryngologist ruled out parotitis and prescribed a 7-day course of prednisone and a 14-day course of amoxicillin clavulanate for “adenitis”, leading to no clinical improvement. An ophthalmologist ordered a retinography that was performed on November 12, 2018. There was a pattern of neuroretinitis in the right eye, with optic disc swelling mainly in the inferior rim, and exudates in a macular star pattern (Figure 1). The left eye was normal. There was no conjunctivitis or ocular pain.

More at this link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310359/

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CrystalRiver