Bartonella hanselae retinitis patient evaluated with multimodal retinal exams
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International Journal of Retina and Vitreous Open Access
CASE REPORT
Bartonella hanselae retinitis patient evaluated with multimodal retinal exams Paulo Alberto Cervi Rosa* , Luis Filipe Nakayama, Vinicius Campos Bergamo, Dante Akira Kondo Kuroiwa and Nilva Simeren Bueno de Moraes
Abstract Background: Cat scratch disease is a systemic infectious illness caused by the bacterium Bartonella henselae. The most common ophthalmological involvement due to infection by Bartonella is Parinaud oculoglandular syndrome, whereas the most common posterior segment findings are neuroretinitis and subsequent late macular star. Moreover, other findings, such as retinal or subretinal lesions, intermediate uveitis and angiomatous lesions, may be present. Case presentation: A 37-year-old female patient with retinal findings and serological confirmation of Bartonella infection was evaluated via multimodal retinal exams. The patient received treatment with doxycycline 100 mg twice daily for 2 weeks. One month after treatment, complete improvement of her visual scotoma symptoms was confirmed. A swept-source optical coherence tomography exam also showed decreases in the size and intraretinal extension of the lesion. Improvement of light perception at the affected area was confirmed by microperimetry. Conclusions: Bartonella henselae infection, particularly retinitis, can present a variable spectrum of clinical and ophthalmological findings. Multimodal retinal exams can clearly identify lesion characteristics, thus providing important information for diagnosis and the evaluation of lesion improvement after antibiotic treatment. Keywords: Bartonella, Multimodal imaging, Retinitis Background Cat scratch disease is a systemic infectious illness caused by the bacterium Bartonella henselae, a gram-negative bacillus responsible for a disease with a variable clinical spectrum [1–3]. The most common ophthalmological manifestation of Bartonella is Parinaud oculoglandular syndrome, first described in 1889, which presents as ulcerative chronic conjunctivitis and lymphadenopathy [1–3]. The most common posterior segment findings are a swollen optic disc, neuroretinitis and subsequent late macular star [1, 4], but other findings may be present, such as retinal or
*Correspondence: [email protected] Physician Department of Ophthalmology, Universidade Federal de São Paulo - EPM, Botucatu St., 821, Vila Clementino, São Paulo 04023‑062, Brazil
subretinal lesions, intermediate uveitis and angiomatous lesions [3]. This case report describes a female patient with retinal findings and serologically confirmed Bartonella infection who was evaluated with multimodal retinal exams, including retinography, swept-source optical coherence tomography (SS-OCT), fundus autofluorescence (FAF), fluorescein angiography (FA), angio-OCT, and microperimetry, before and after antimicrobial treatment.
Case report A 37-year-old female presented at the emergency sector with a chief complaint of paracentral visual scotoma in her left eye for 3 weeks. She referred that th
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