Introduction Bartonella henselae neuroretinitis represents an infectious etiology of painless vision loss due to optic neuropathy and maculopathy. Although self-limiting, prompt treatment is imperative in shortening the course of active infection and preventing permanent vision loss. Neuroretinitis due to B henselae is likely underdiagnosed due to several infectious and noninfectious etiologies that may present the same way. This case report will outline the transmission, ocular signs, disease progression, and accepted clinical management of neuroretinitis caused by B henselae. Case Report A 46-year-old man presented to the eye clinic reporting progressive vision loss in the right eye more than the left eye over the past week, a central scotoma in the right eye, pressure in both eyes, and headaches. His best-corrected visual acuity was 20/400 in the right eye and 20/20 in the left eye. A dilated eye examination revealed hyperemic optic nerve edema, macular edema, intraretinal hemorrhages, and cotton wool spots in both eyes. Systemic findings included an elevated hemoglobin A1c, elevated blood pressure, and positive B henselae titers. He was started on oral doxycycline for the positive Bartonella titers. At the 2-month follow-up visit, his best-corrected visual acuity was 20/20 in both eyes with marked improvement of the macular edema and exudates with some residual optic nerve pallor in both eyes. A visual field defect remained in the left eye. Conclusion B henselae is an infectious etiology of neuroretinitis that can lead to painless vision loss. The disease course tends to be self-limiting, although prompt treatment may shorten infection time and prevent permanent visual symptoms. Other infectious and noninfectious etiologies must not be overlooked as they can present the same way. Thorough patient history, serology testing, and an understanding of transmission can aid in proper diagnosis and management.
Pangborn et al. (Fri,) studied this question.