SEROLOGY NEGATIVE BARTONELLA NEURORETINITIS IN AN IMMUNOCOMPROMISED PATIENT. Issue Volume 16:Issues 1(2022) (3rd March 2020)

• Record Type: Journal Article
• Authors: Wu, Annie M.; Zhao, Peter Y.; Wubben, Thomas J.; Hyde, Robert A.; Paulus, Yannis M.; Johnson, Mark W.
• Is Part Of: Retinal cases & brief reports. Volume 16:Issues 1(2022)
• Page Start: 36
• Page End: 39
• Publication Date: 2020-03-03
• Subjects: Bartonella henselae -- cat-scratch disease -- immunocompromise -- neuroretinitis -- PCR -- seroconversion -- vitrectomy; Retina -- Diseases -- Periodicals; Retina -- Periodicals; Retinal Diseases -- Periodicals; Retina -- Case Reports; Retinal Diseases -- Case Reports; 617.7
• DOI: 10.1097/ICB.0000000000000995
• Languages: English
• ISSNs: 1935-1089

Abstract

Abstract : We report a case of serology-negative severe disseminated Bartonella infection in an immunocompromised patient presenting with bilateral chorioretinitis and multifocal intracerebral lesions. Diagnosis was made by detection of B. henselae DNA by universal polymerase chain reaction of brain tissue. Abstract : Background/Purpose: To report a case of serology-negative severe disseminated Bartonella neuroretinitis in an immunocompromised patient in which diagnosis was made by detection of B. henselae DNA by universal polymerase chain reaction of brain tissue. Methods: Case report. Results: A 57-year-old man with immunoglobulin A vasculitis on immunosuppressive therapy presented with lethargy, weight loss, and bilateral decreased vision. Fundus examination revealed bilateral mild vitritis, marked optic disc edema, vascular sheathing, and numerous white inner retinal and preretinal lesions. Brain magnetic resonance imaging revealed multiple foci of restricted diffusion and a ring-enhancing focus in the left parietal lobe. Serologies, cerebrospinal fluid, and vitreous biopsies were all negative for Bartonella . A brain biopsy was performed and B. henselae DNA was detected by universal polymerase chain reaction of the specimen. The patient demonstrated resolution of fundus findings with antibiotic treatment. Repeat serological testing demonstrated seroconversion. Conclusion: In immunocompromised patients, infection by Bartonella henselae can present as severe disseminated disease. Establishing the diagnosis can be challenging as serologic testing is often unrevealing in the setting of a blunted immune response. Polymerase chain reaction has been used in select cases to establish the diagnosis.