1. 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

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

3. 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

4. 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

5. 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

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

7. Initial Diagnosis
Neuroretinitis

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

9. Bartonella Neuroretinitis
Final diagnosis
Bartonella Neuroretinitis
(cat scratch disease)

10. Treatment
doxycycline 100mg
twice a day
for 4 weeks

11. 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)

12. 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