Bartonella Neuroretinitis Sana Khochtali Wafa Ammari Salim Ben Yahia Department of ophthalmology Fattouma Bourguiba University Hospital Faculty of Medicine and University of Monastir, Monastir, Tunisia

History A 38-year-old male patient No significant medical history Vision loss in the OD 5 days before presentation

February 2014 Visual acuity OD 20/400, OS 20/20 No AC inflammatory reaction OU +1 cells in the vitreous, OD Relative afferent pupillary defect , OD

Fundus photograph of the OD shows a prominent optic disc swelling, lipid exudation arranged in a partial macular star , and exudative retinal detachment (ERD) involving the fovea Fundus photograph of the OS : unremarkable findings

Optical Coherence tomography Spectral-domain optical coherence tomography (SD-OCT) of the OD confirms the presence of ERD seen on clinical examination. Note the presence of intraretinal fluid and small hyperreflective dots corresponding to hard exudates nasally

Fluorescein angiography leakage from the optic disc no evidence of retinal capillary abnormalities in the macula

Initial Diagnosis Neuroretinitis

Work-up Contact with cats Systemic examination : unremarkable Tuberculin-skin test : negative Chest X-ray : normal Serologies Syphilis and rickettsiosis : negative Bartonella Henselae : positive

Bartonella Neuroretinitis Final diagnosis Bartonella Neuroretinitis (cat scratch disease)

Treatment doxycycline 100mg twice a day for 4 weeks

Follow-up - 8 weeks improvement of visual acuity (OD: 20/25) disappearance of optic disc swelling, resolution of ERD persistence of hard exudates (resolution after 6 months)

Conclusion Neuroretinitis is a particular form of optic neuritis. It needs to be differentiated from other causes of optic disc edema and macular star Cat scratch disease is the most common cause of neuroretinitis. Other infectious and non-infectious causes of neuroretinitis should be ruled out Bartonella neuroretinitis usually has a self-limited course