Don’t jump the gun: bartonella neuroretinitis mimicking tuberculosis neuroretinitis. Dont't jump the gun

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Published: Jun 1, 2021
DOI: https://doi.org/10.36281/2021010103
Keywords:
Bartonella Neuroretinitis Tuberculosis

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Pooi Wah Lott
University of Malaya
Dr. Jacob
1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)
Dr. Chye Li
1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)
Associate Professor
1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)
Associate Professor
1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)
Dr. Sujaya
1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)

Abstract

ABSTRACT:


Title: Don’t jump the gun:bartonella neuroretinitis mimicking tuberculosis.


Objective: To report a case of Bartonella Neuroretinitis mimicking Tuberculosis


Method: Case Report and Literature Review


A 24-year-old woman presented with sudden episode of left painless blurring of vision. It was preceded with high grade fever a month ago. On examination, her visual acuity was 6/6 and 6/36 respectively with no relative afferent pupillary defect (RAPD).  The left posterior segment examination showed a swollen hyperemic disc with a normal macula.


She was investigated for left optic neuropathy and had an elevated erythrocyte sedimentation rate with positive tuberculin skin test (TST) measured 20mm. Fundus fluorescein angiography (FFA) showed presence of focal choroiditis and vasculitis in the left eye. It is highly suspicious of ocular tuberculosis based on the clinical findings and investigation results. Ten days later her left vision deteriorated to 2/60, grade 3 RAPD and a macula star. The patient also developed tender left cervical lymphadenopathy. Bartonella Serology was sent and showed positive result. She regained normal vision and optic nerve function after 6 weeks course of oral Doxycycline.


Conclusion: This is an unusual clinical presentation of Bartonella neuroretinitis with diagnostic challenge as its initial presentations mimicked ocular tuberculosis. In conclusion, a detailed history, clinical acumen, and laboratory investigations are crucial in making an accurate diagnosis prior to commencement of treatment.


Conflicts of Interest: The author report no conflicts of interest.


 


Keywords: Bartonella,Neuroretinitis,Tuberculosis


 

Article Details

Issue
Vol. 16 No. 1 (2021): January-June 2021
Section
Case Report
Author Biographies

Dr. Jacob, 1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)

Ophthalmology Trainee at the Department of Ophthalmology, Faculty of Medicine, University of Malaya

Ophthalmology Medical Officer at the Department of Ophthalmology, University Malaya Medical Center

Dr. Chye Li, 1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)

Ophthalmology Trainee/ Registra at the Department of Ophthalmology, Faculty of Medicine, University of Malaya

Ophthalmology Medical Officer at the Department of Ophthalmology, University Malaya Medical Center

Associate Professor, 1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)

Associate Professor and Medical Retina Consultant at the Department of Ophthalmology, Faculty of Medicine University of Malaya

Medical Retina Consultant at the Department of Ophthalmology, University Malaya Medical Center

Associate Professor, 1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)

Associate Professor and Glaucoma Consultant, Department of Ophthalmology, Faculty of Medicine, University of Malaya

Glaucoma Consultant, Department of Ophthalmology, University Malaya Medical Center

Dr. Sujaya, 1)Ophthalmology Department, Faculty of Medicine, University of Malaya, Malaysia 2)Ophthalmology Department University Malaya Medical Centre, Malaysia 3) University Malaya Eye Research Centre (UMERC)

Cornea Consultant, Department of Ophthalmology, Faculty of Medicine, University of Malaya

Clinical Specialist & Cornea Consultant, Department of Ophthalmology, University Malaya Medical Center

References

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