Images in Clinical Medicine
Bartonella Neuroretinitis
N Engl J Med 2000; 343:1459November 16, 2000
- Article
Figure 1 A 26-year-old man who presented with blurred vision was found to have bilateral papilledema and diminished visual acuity (20/60). Magnetic resonance imaging of the brain and orbits was normal, and an examination of cerebrospinal fluid showed 120 monocytes per cubic millimeter. A diagnosis of aseptic meningitis and neuroretinitis was made. On questioning, the patient revealed that he had recently acquired two playful kittens and that he had had transient swelling of a right cervical lymph node two weeks before his vision became blurred. Macular edema with stellate exudates developed in his right eye, and empirical treatment with a four-week course of doxycycline and rifampin was initiated for presumed cat scratch disease. Although initial studies were negative, subsequent serologic tests were diagnostic of Bartonella henselae infection: at week 1, the serum IgG level was less than 256 mg per deciliter and tests for IgM were negative, whereas at week 3, the IgG titer was 1:4096 and tests for IgM were positive. This gram-negative organism is the causative agent of cat scratch disease. The patient's vision improved rapidly, returning to normal (20/20) by the conclusion of therapy, and a retinal examination two months after the onset of illness showed complete resolution of the macular edema and exudates.
Kenneth C. Earhart, M.D.
Michael H. Power, M.D.
Naval Medical Center, San Diego, CA 92134-1201- Citing Articles (2)
Citing Articles
1
Valerie Purvin, Seema Sundaram, Aki Kawasaki. (2011) Neuroretinitis: Review of the Literature and New Observations. Journal of Neuro-Ophthalmology 31:1, 58-68
CrossRef2
A. Safdar, P. L. McEvoy, R. G. Burns, J. R. Perfect. (2002) Clinical microbiological case: severe relapsing septal panniculitis in a healthy man from the south-eastern USA. Clinical Microbiology and Infection 8:12, 830-832
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