PMC7554364_01
Bartonella henselae neuroretinitis in a 51-year-old woman (case 1). Color fundus photography (A) in the right eye (RE) and (B) in the left eye (LE) at presentation. Black arrows show focal retinal whitening corresponding to retinitis in both eyes. Yellow arrow highlights macular fluid & lipid constituing a macular star. Magnified insets display optic disc edema, more in the RE than in the LE. Fluorescein angiography of the RE (C) and LE (D) depicts late hyperfluorescence from focal retinitis (white arrows) in both eyes. Yellow arrows also show late hyperfluorescence which extends beyond optic disc boundaries. Spectral-domain optical coherence tomography (SD-OCT) B-scans over the macula and optic disc in the RE (E) and LE (F) confirmed central subretinal fluid (black arrow in E) and bilateral optic disc edema (blue arrows in E and F). The green and red lines indicate the location and direction of the SD-OCT B scans.
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Focal retinitis with overlying vitreous cells was present along the retinal vascular arcades in both eyes (Fig. 1).
Three-month follow-up imaging of case 1 as seen on (A) color fundus photograpy in the RE. Magnified inset shows retinal exudates temporal to optic disc, which still presents residual edema. Color fundus photograph (D) in the LE shows a subtle flame hemorrhage near superior pole of the optic disc. The green and red lines in B, C, E and F indicate the location and direction of the SD-OCT B scans below. The B-scans in (B) confirm absence of macular edema and much less swelling of the optic disc in (C). The B scans in (E) and (F) demonstrate no neuroretinitis. The gray arrow in (D) indicates the location and direction of an SD-OCT B-scan at presentation (G) through focal retinitis and after 6-weeks treatment in (H), with resolution of the retinitis and residual ellipsoid zone damage. A subtle chorioretinal scar in (D) indicates healing.
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Following 6-weeks of oral azithromycin 500 mg/daily and ketorolac ophthalmic solution 0.5 % four times a day for two weeks in the RE, visual acuity improved to 20/20 in both eyes (Fig. 2).
PMC7554364_02
Bartonella henselae neuroretinitis in a 19-year-old man (case 2). Color fundus photograph (A) of the right eye (RE) shows a focal area of retinitis in the temporal macula along the inferotemporal vascular retinal arcade. Fluorescein angiography (FA) of the RE (B, C) displays leakage from this retinal area. Optic disc shows subtle hyperemia and mild FA staining at the nasal margin of the disc. Magnified color fundus photography of the LE in (D) highlights optic disc edema and a subtle radial lines due to macular edema and/or subretinal fluid, partially blocked by an imaging artifact. Magnified FA imaging depicts temporal disc edema in (E) and late hyperfluorescence in (F) due to leakage. Macula images in (G) and (H) also show a subtle central ring of hyperfluorescent staining.
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LE highlighted hyperemia of the whole optic disc and radiate foveal edema resembling a hemi-macular star. Late disc leakage in the LE was identified on fluorescein angiography (FA) (Fig. 3).