Rickettsial neuroretinitis: A report of 2 cases

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Purpose

The authors present two cases of neuroretinitis caused by Rickettsia rickettsii infection.

Observations

Case 1 is a 24-year-old male who presented with 2 months of vision loss. Case 2 is a 38-year-old female who presented with 4 weeks of eye pain and vision loss. Examination of both patients revealed neuroretinitis characterized by optic disc swelling with macular exudates, and subsequent serological analysis was positive for Rickettsia rickettsii. Both patients responded favorably to treatment with oral doxycycline and prednisone.

Conclusions and importance

Given the potential for neuroretinitis to cause permanent vision loss, the presence of acute vision loss, optic disc edema, and macular exudates should prompt an evaluation for Rickettsial disease in endemic areas, even in the absence of systemic symptoms or known history of a tick bite.

Related collections

Most cited references 7

Record: found
Abstract: found
Article: not found

Neuroretinitis: review of the literature and new observations.

Mahalingam S. Sundaram, Aki Kawasaki, Valerie Purvin (2011)

Neuroretinitis (NR) is an inflammatory disorder characterized by optic disc edema and subsequent formation of a macular star figure. The underlying pathophysiology involves increased permeability of disc vasculature, but the etiology is not fully defined. In some cases, NR is probably due to an infectious process involving the disc; in others, a postviral or autoimmune mechanism is more likely. Cases can be divided into those in which a specific infectious agent has been identified, those considered idiopathic, and those with recurrent attacks. Some reports have not distinguished among these subgroups, and it is unclear if their clinical features vary. We reviewed the literature and our own patients looking particularly at features that might better distinguish these subtypes. Features common to all 3 groups included age, absence of pain, and fundus appearance. Preceding systemic symptoms were more common in patients with cat scratch disease (CSD) and uncommon in those with recurrence. The pattern and magnitude of visual field loss differed, more commonly confined to the central field in CSD cases and more severe in recurrent cases. Recovery of visual acuity and field was less substantial in recurrent cases even after the initial episode. MRI was usually normal in all 3 groups. Enhancement confined to the optic disc was found in all 3 groups, but enhancement of the retrobulbar optic nerve was seen only in recurrent cases. Findings that are strongly suggestive of CSD include very young age, preceding systemic symptoms, and poor visual acuity but with a small or absent relative afferent pupil defect (RAPD). In contrast, the following are suggestive of idiopathic NR with a high risk of recurrence: absence of systemic symptoms, visual field defect outside the central field, preserved visual acuity with a large RAPD, and poor recovery of vision. Decisions regarding evaluation and treatment should be made with these features in mind.

0 comments Cited 31 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Visual loss associated with rickettsial disease.

Rim Kahloun, Salma Gargouri, Nesrine Abroug … (2014)

Abstract Purpose: To characterize and analyze ocular involvement associated with visual loss in a cohort of patients with rickettsial disease.

0 comments Cited 25 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Neuroretinitis: a review.

Aliaa Abdelhakim, Nailyn Rasool (2018)

Neuroretinitis is an inflammatory disorder of the eye presenting with optic disc edema and the delayed development of a macular star secondary to optic nerve swelling toward the macular structures. Neuroretinitis can be divided into idiopathic, infectious (including neuroretinitis associated with cat scratch disease) and recurrent.

0 comments Cited 20 times – based on 0 reviews      Review now

All references

Author and article information

Contributors

Akshay S. Thomas

Journal

Journal ID (nlm-ta): Am J Ophthalmol Case Rep

Journal ID (iso-abbrev): Am J Ophthalmol Case Rep

Title: American Journal of Ophthalmology Case Reports

Publisher: Elsevier

ISSN (Electronic): 2451-9936

Publication date PMC-release: 27 February 2021

Publication date Collection: June 2021

Publication date (Electronic): 27 February 2021

Volume: 22

Electronic Location Identifier: 101065

Affiliations

[a ]UH Regional Hospitals, 27100 Chardon R, Richmond Heights, OH, 44143, USA

[b ]Tennessee Retina, 345 23rd Ave N, Ste 350, Nashville, TN, USA, 37203

Author notes

[∗ ]Corresponding author. 345 23rd Ave N, Ste 350, Nashville, TN, 37203. akshaysthomas@ 123456gmail.com

Article

Publisher Item ID: S2451-9936(21)00056-6 Publisher ID: 101065

DOI: 10.1016/j.ajoc.2021.101065

PMC ID: 7937658

SO-VID: a09de5ea-83ca-451c-85f5-dd1d40159f13

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 21 June 2020

Date revision received : 14 February 2021

Date accepted : 20 February 2021