A patient with past ocular history of viral conjunctivitis presented with 2 weeks of decreased vision in the right eye. His exam was notable for visual acuity of 20/80+1 in the right eye and 20/20 in the left eye. Intraocular pressures were 17 and 19. The patient had a partial outer temporal visual field defect by confrontational visual fields. Anterior segment exam was unremarkable in both eyes. Posterior segment exam revealed grade V optic disc edema, temporal optic disc hemorrhage, 360 degrees of subretinal fluid extending from the optic disc, tortuous vessels, and retinal whitening in the distribution of a nasal branch artery. MRI demonstrated mild asymmetric bulging of the right optic nerve head into the right posterior sclera, with slight right optic nerve distention, and subtle right-sided papillitis. Fundus autofluorescence demonstrated hypoautofluorescence consistent with optic disc edema. Optical coherence tomography demonstrated peripapillary intra- and subretinal fluid. Fluorescein angiography showed profuse disc leakage and nonperfusion in a nasal branch artery consistent with branch retinal artery occlusion. The patient was presumptively diagnosed with ocular-involving Bartonella henselae infection and started on doxycycline 100 mg PO BID. On day 8, visual acuity improved to 20/40 and an oral prednisone taper was added to the treatment regimen. At 24 days, visual acuity was 20/30 and on day 25, Bartonella henselae IgG and IgM were positive. At 2 months, the patient reported subjective improvement of his visual acuity but persistence of the visual field defect.
Presentation Date: 10/07/2021
Issue Date: 11/05/2021