Author: Rahma Mesfar (Tunisia)
Co-authors: Saloua Ben Amor, Sofien Affès, Takwa Sammouda, Arij Mehdi, Imen Abid, Amira Trigui
Purpose
To describe the clinical presentation, diagnosis, treatment modalities, and prognosis of Rickettsia rickettsii retinitis.
Setting/Venue
Department of Ophtalmplogy, Habib Bourguiba University Hospital, Faculty of medicine, University of Sfax, Tunisia.
Methods
A 60-year-old woman, living in a rural area, complaining of acute visual loss, floaters and ocular pain over a 5-day period. History was notable for skin rash and fever 3 weeks before clinical presentation. The patient underwent a comprehensive ocular examination, fluorescein angiography, swept-source optical coherence tomography (OCT).
Results
Ophtalmic examination revealed a best corrected visual acuity (BCVA) reduced to counting fingers, ciliary flush, granulomatous anterior uveitis and moderate vitritis. Intraocular pressure was normal. Fundoscopy showed large areas of multiple white spots at the level of the inner retina associated with vascular sheathing and hyperemic disc with slightly indistinct borders within both eyes. Fluorescein angiography showed early hypofluorescence and late staining of large retinal foci, while OCT revealed a serous retinal detachement. Serological analysis was positive for Rickettsia rickettsii. The patient was treated with a 2-week course of oral doxycycline 200 mg/day. One month later, almost all retinal lesions disappeared and visual acuity improved.
Conlusions
Rickettsia rickettsii is one of the many possible infectious agents that can cause retinitis. Mild vitritis, retinal vasculitis, optic disc staining, white retinal lesions, retinal hemorrhages, and multiple hypofluorescent choroidal dots are the most common manifestations of posterior segment manifestations of Rickettsia conorii infection. Highly suspicion based on history can guide testing, particularly in patients in endemic areas. Doxycycline is effective in treating the condition.
Financial Disclosure
Department of Ophtalmplogy , Habib Bourguiba University Hospital , Faculty of medicine , University of Sfax , Tunisia.
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