Severe bilateral retinal vasculitis as a delayed manifestation of rickettsial infection

Ophthalmic manifestations of rickettsial infections are reported as mostly asymptomatic and self-limiting. A 27-year-old woman, 29 weeks pregnant, recently treated for rickettsial infection, presented ten days following discharge with visual blurring and was diagnosed to have severe bilateral retinal vasculitis. Rickettsial antibody testing (indirect immunofluorescence assay) revealed Rickettsia conorii IgG titer >1:128. Antinuclear antibody, retroviral, syphilis and toxoplasmosis screens were negative. Bilateral intra-vitreous triamcinolone, azithromycin and prednisolone were administered. However, despite some improvement, a residual visual deficit remained. This case report highlights the possibility of debilitating visual loss following rickettsial infections, need for ophthalmic screening at diagnosis and prompt treatment initiation.