https://orcid.org/0000-0002-0538-3528
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ABSTRACT
Purpose
To characterize an unusual presentation of infectious posterior uveitis using multimodal imaging, and discuss the clinical decision-making involved in diagnosis and treatment.
Methods
Wide-field fundus photography, swept-source optical coherence tomography (OCT), swept-source OCT angiography, fluorescein angiography, and indocyanine green angiography.
Results
This patient presented with cyclical fevers and blurry vision. Fundus examination revealed bilateral optic disc edema, macular intraretinal white spots and many scattered yellow-white chorioretinal lesions. Multimodal imaging characteristics suggested that many of these lesions represent choroidal granulomas. Extensive systemic workup was only notable for borderline elevated Bartonella henselae IgG titers (1:128), however convalescent IgG titers were elevated at 38 days (1:512) supporting the diagnosis of Bartonella chorioretinitis.
Conclusion
Ocular manifestations of Bartonella henselae infection are varied and may include choroidal granulomas. Multimodal imaging characteristics may help identify etiologies of infectious uveitis. Convalescent titers are important when evaluating patients with suspected Bartonellosis, especially patients with atypical presentations.
Acknowledgments
The authors wish to acknowledge and thank this patient for her generosity in allowing her case to be reported.
Consent for publication
The patient featured in this case report has provided informed consent for this publication and the signed consent form is available for review.
Authors’ contributions
AA and ZK were responsible for conception of the report and drafting the manuscript. ZK and OB prepared the figures. OB assisted with data acquisition and analysis. EC, ME, GB, and KK provided substantial editorial contributions and assisted with interpretation of images. PV, JV, and JS provided substantial editorial contributions. All authors read and approved the final manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).