The n e w e ng l a n d j o u r na l
Images in Clinical Medicine
Rachael L. Niederer, M.B.,
Ch.B., Ph.D.
Haya H. Al-Ani, M.B., Ch.B.
University of Auckland School of Medicine
Auckland, New Zealand
hayaa@adhb.govt.nz
This article was published on March 6,
2021, at NEJM.org.
952
Downloaded from nejm.org on March 15, 2021. For personal use only. No other uses without permission.
Copyright © 2021 Massachusetts Medical Society. All rights reserved.
of m e dic i n e
Chana A. Sacks, M.D., Editor
Bartonella Neuroretinitis
A
55-year-old woman presented to the ophthalmology clinic with
blurry vision and pain in the right eye that had persisted for several days.
She had no associated fever or lymphadenopathy. An ocular examination
revealed severe vision loss (she could only count fingers), a relative afferent pupil-
lary defect, and reduced color vision in the right eye. A slit-lamp examination
showed anterior-segment inflammation, a swollen optic nerve with hemorrhages
in the nerve fiber layer, and serous macular detachment. A fundus examination
revealed macular edema with stellate exudates, findings that are consistent with
bartonella infection. This diagnosis was supported by the results of serologic
evaluation: at week 1, the IgM antibody titer to Bartonella henselae was 80 mg per
deciliter, and the IgG antibody titer was 256 mg per deciliter; on repeat testing at
week 3, the IgG antibody titer had increased to 1024 mg per deciliter. Other pos-
sible infectious causes of neuroretinitis include toxoplasmosis and syphilis, although
many cases are idiopathic. Bartonella henselae is the causative agent of cat scratch
disease; in the current case, the patient had been exposed to cats but recalled no
recent scratch. Treatment with topical glucocorticoid drops, oral doxycycline, and
oral prednisone was initiated. The macular edema, nerve swelling, and relative
afferent pupillary defect resolved, and the patient regained visual acuity of 20/80
in the right eye.
DOI: 10.1056/NEJMicm2005549
Copyright © 2021 Massachusetts Medical Society.
n engl j med 384;10 nejm.org March 11, 2021
The New England Journal of Medicine