Neuroretinitis caused by Bartonella quintana

A 57-year-old woman presented to the eye clinic for impaired vision on the left eye persisting for three months. Clinical examination revealed massive peripapillary exudate and stellate macular exudate, raising suspicion of a cat-scratch disease. Tetracycline therapy was introduced, followed by azithromycin and topical corticosteroids. Serologic testing for Bartonella henselae and Bartonella quintana was performed. In the first sample, Bartonella quintana IgG titer was 128, and IgM titer 20, whereas in repeat sample the respective findings were 64 and negative. Such a titer dynamics pointed to Bartonella quintana infection. The prescribed therapy resulted in vision improvement and normalization of the clinical picture. After nine months of therapy initiation, macular exudate had almost completely disappeared. Based on the patient's history, symptoms, therapeutic response and IgM pattern, the neuroretinitis must have developed secondary to Bartonella quintana infection.