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Updated: Feb 3, 2026
Multifocal Electroretinograms
Published on: December 4, 2011
Acute multifocal retinitis: a retrospective review of 35 cases
Sana Khochtali1, Salma Gargouri2, Sourour Zina1
1Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia.
Background:
Acute multifocal retinitis is a rare condition that has been considered to be often idiopathic. The purpose of this study was to analyze clinical features and causes of acute multifocal retinitis.
Results:
This study is a retrospective review of the charts of 35 patients with acute multifocal retinitis. Patients with three or more retinal lesions in at least one eye, with at least one lesion of less than 500 μm in size were included. All patients had complete ophthalmological examination, fundus photography, and fluorescein angiography. Twelve patients (34.3%) had optical coherence tomography. An extensive work-up was performed including a detailed comprehensive medical history, examination by an internist and an infectious disease specialist, a chest X-ray, Mantoux test, and laboratory tests for syphilis, human immunodeficiency virus, Bartonella, and Rickettsia. Of the 35 patients, 25 (71.4%) had bilateral involvement and 10 (28.6%) had unilateral involvement (total number of eyes: 60). Mean best-corrected visual acuity (BCVA) was 20/25 (range, 20/1000-20/20). Retinal lesions ranged from 3 to more than 20 in number in at least 1 eye, and from 150 to 1500 μm in size. Associated findings included mild anterior chamber inflammation in 5 eyes (8.3%), mild vitritis in 46 eyes (76.7%), optic disc swelling in 9 eyes (15%), macular star in 4 eyes (6.7%), exudative retinal detachment in 6 eyes (10%), and branch retinal artery occlusion in 6 eyes (10%). Acute multifocal retinitis was found to be caused by Rickettsia conorii infection in 20 patients (57.1%), Rickettsia typhi infection in 4 patients (11.4%), cat-scratch disease in 8 patients (22.9%), and syphilis in 1 patient (2.9%). It was idiopathic in two patients (5.7%). Retinal lesions resolved without scarring in 3 to 12 weeks in all but three eyes (5%), in which residual retinal pigment epithelial changes were noted.
Conclusion:
Rickettsial disease was the most common cause of acute multifocal retinitis. Other identified causes included cat-scratch disease and syphilis, and a very small subset of patients was diagnosed with idiopathic multifocal retinitis.
Insights
Rickettsial infections are the leading cause of acute multifocal retinitis, a rare eye condition. This study identified Rickettsia, cat-scratch disease, and syphilis as key causes, with few idiopathic cases.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Retinal Diseases
Background:
- Acute multifocal retinitis is a rare condition often presumed idiopathic.
- Understanding its causes is crucial for effective diagnosis and treatment.
Purpose of the Study:
- To analyze the clinical features and identify the causes of acute multifocal retinitis.
Main Methods:
- Retrospective review of 35 patients with acute multifocal retinitis.
- Comprehensive ophthalmological examination, fundus photography, fluorescein angiography, and extensive medical work-up including infectious disease specialist consultation and serological tests.
- Optical coherence tomography performed in 12 patients.
Main Results:
- Rickettsial infections (Rickettsia conorii and Rickettsia typhi) were the most common cause (68.5%).
- Cat-scratch disease (22.9%) and syphilis (2.9%) were also identified causes.
- Idiopathic cases accounted for a small subset (5.7%).
- Common associated findings included vitritis (76.7%) and optic disc swelling (15%).
Conclusions:
- Rickettsial disease is the predominant cause of acute multifocal retinitis.
- Cat-scratch disease and syphilis are other significant infectious etiologies.
- A small percentage of cases remain idiopathic.
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