OCULAR BARTONELLOSIS PRESENTING WITH FOCAL CHOROIDITIS, FOCAL RETINITIS, BRANCH RETINAL ARTERY OCCLUSION, AND PARACENTRAL ACUTE MIDDLE MACULOPATHY: LONGITUDINAL MULTIMODAL IMAGING ANALYSIS.

Abstract

To report an atypical case of ocular bartonellosis evaluated longitudinally with multimodal imaging and review the literature on the less common posterior segment manifestations of bartonella infection. Case report and review of the literature. A 26-year-old man presented with focal choroiditis in the right eye and focal retinitis, a branch retinal artery occlusion, and paracentral acute middle maculopathy in the left eye after a systemic prodrome including headache and lymphadenopathy. Serologic testing revealed positive bartonella immunoglobulin G with a titer of 1:512. The patient was diagnosed with ocular bartonellosis infection and started on systemic doxycycline. The posterior segment findings resolved over the follow-up period, and their resolution was documented with optical coherence tomography. Neuroretinitis is the classic ocular finding in cat scratch disease, but less common presenting findings may include focal choroiditis, retinitis, and branch retinal artery occlusion. To the best of our knowledge, this is the first report of paracentral acute middle maculopathy secondary to a retinitis-associated branch retinal artery occlusion as a presenting sign in ocular bartonellosis.