optic disk edema and macular serous retinal detachment as an early sign of bartonella henselae...
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![Page 1: Optic disk edema and macular serous retinal detachment as an early sign of Bartonella henselae systemic infection Dr. Carlos Alvarez-Guzmán 1 Dr. Alejandro](https://reader035.vdocument.in/reader035/viewer/2022070412/56649e0f5503460f94afa790/html5/thumbnails/1.jpg)
Optic disk edema and macular serous retinal detachment as an early sign of Bartonella
henselae systemic infection
Dr. Carlos Alvarez-Guzmán 1
Dr. Alejandro Rodríguez-García 2
1 Ophthtalmology resident. Escuela de Biotecnología y Salud, Tecnológico de Monterrey – Mexico
2 Chief director of Ocular Immunology and Uveitis Clinics; Academic Director of Ophthalmology Residency. Escuela de Biotecnología y Salud, Tecnológico de Monterrey-Mexico
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Patient history and clinical exam
• 38 y/o male with a 4-day history of flu-like illness and blurred vision in his LE .
• Medical history– Hyperlipidemia.
• Medications: none• Social history
– Parrots, tucans and macaws as pets.
• VA: OD 20/15; OS 20/30• Amsler: cecocentral scotoma OS• Rx: OD PL, OS +0.50• S/C: White and quiet• AC: D&Q• Pupils: 3mm, LR +2, No RAPD• IOP: 14 mmHg OU• Fundus exam OS: optic disc edema,
mild hyperemia and flame shaped hemorrhage associated with peripapillary serous retinal detachment of 3 DD. Clear vitreous.
![Page 3: Optic disk edema and macular serous retinal detachment as an early sign of Bartonella henselae systemic infection Dr. Carlos Alvarez-Guzmán 1 Dr. Alejandro](https://reader035.vdocument.in/reader035/viewer/2022070412/56649e0f5503460f94afa790/html5/thumbnails/3.jpg)
Late leakage of optic nerve
OD within normal limits
Late leakage of optic nerveLate leakage of optic nerveLate leakage of optic nerve
Optic disc edema with loss of foveal reflex: macular RD
Optic disk edema and hemorrage
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• 3 weeks later a macular star developed and optic disc started to resolve
• VA improved to 20/40• Prednisolone was started
40mg/day PO for 3 weeks
• 11 weeks later optic disk edema resolved
• Macular exudates diminished• VA improved to 20/25• Prednisolone was tapered.
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Diagnostic tests
• CBC with differential, RPR, FTA ABS, PPD and CXR within normal limits.
• Serum anti-Bartonella henselae– IgG 1:2560, IgM 1:800
• Started on:– Doxycycline 100mg PO bid– Rifampicin 300mg PO bid
• One week later VA decreased to 20/200 and optic disc edema persisted.
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Discussion• Neuroretinitis is a unique form of optic neuropathy associated with a
complete or partial macular star.
• Optic disk edema associated with peripapillary serous retinal detachment appears to be a common yet unrecognized sign of systemic B. henselae infection.
• Many patients will develop a macular star within weeks of the onset of visual symptoms.
• Early signs that help to distinguish B.henselae associated papillitis from other forms of anterior optic neuropathy are important for both diagnosis and therapy.
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References1. Kevin Wade MDCM, et al. Optic disk edema associated with peripapillary serous retinal detachment: an early sign of systemic Bartonella henselae infection. Am J Ophtalmol 2000;130:327-334.
2. Solley W., et al. Cat scratch disease. Posterior Segment Manifestations. Ophthalmology 1998;106:1546-1553.
3. Reed et al. Bartonella henselae neuroretinitis in cat scratch disease. Ophthalmology 1998;105:456.466.
4. Zacchei AC, et al. Serous retinal detachment of the macula associated with cat scratch disease. Am J Ophtalmol 1995;120:796-797.
5. Suhler EB, et al. Prevalence of serologic evidence of cat-scratch disease in patients with neuroretinitis. Opthalmology 2000;107:871-876.