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  • Grand Rounds

    A patient with a history of Crohns disease controlled with infliximab presented with 2 weeks left sided blurred vision. He had recently been admitted to the hospital for fever of unknown origin where extensive testing was performed and he was evaluated by infectious diseases. Vision was 20/25 in the right eye and 20/40 in the left eye. Exam was notable for multifocal subretinal lesions in both eyes, with a choroidal subfoveal lesion in the left eye with associated serous retinal detachment. Fluorescein angiography revealed staining of the lesions without leakage. MRI revealed mild enhancement of the left optic nerve sheath. Physical exam revealed a healed scratch mark on the patients arm and tender regional lymphadenopathy. The diagnosis of multifocal choroiditis due to bartonella henselae was made and corroborated by lab results. The patient’s ocular condition improved on Rifampin and Doxycycline therapy. Bartonella Henselae is a zoonotic bacterial infection transmitted between domestic cats through fleas, and to humans by direct inoculation by a cat scratch. Ocular manifestations are present in approximately 4-5% of patients with clinical cat scratch disease. Manifestations can include granulomatous conjunctivitis, neuroretinitis, and choroiditis. While the disease is usually self-limited, antibiotic treatment may be employed. There is limited data on the use of anti-VEGF injections or steroids as adjuvant therapy. Bartonella should thus be on the differential diagnosis for white-dot syndromes in the appropriate clinical context.

    Presentation Date: 08/03/2023
    Issue Date: 08/18/2023