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Bartonella henselae-associated recurrent, bilateral segmental periphlebitis
Caleb C Ng1,2, Joshua Ng2, H Richard McDonald2,3
1Retina Consultants of Orange County, Fullerton, CA, USA.
American Journal of Ophthalmology Case Reports
|March 24, 2022
Summary
A patient with Bartonella henselae-associated ocular inflammation experienced recurrent retinal periphlebitis. Multiple antibiotic courses were required to manage this rare, recurring condition, ultimately leading to scarring.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Medical Microbiology
Background:
- Bartonella henselae (B. henselae) can cause ocular inflammation, though atypical presentations are rare.
- Segmental retinal periphlebitis is an uncommon manifestation of B. henselae infection.
Observation:
- A 32-year-old man presented with recurrent, bilateral segmental retinal periphlebitis and paravenous inflammation.
- Initial treatment with doxycycline showed temporary improvement, but symptoms recurred.
- A dual antibiotic regimen of doxycycline and rifampin was ultimately successful in achieving long-term remission.
Findings:
- The patient required multiple courses of antibiotics over several years due to recurrent ocular inflammation.
- Multimodal imaging confirmed bilateral segmental retinal periphlebitis, paravenous inflammation, and eventual scarring.
- Elevated B. henselae antibody titers supported the diagnosis, despite an otherwise unrevealing serology.
Implications:
- This case highlights the potential for recurrent and persistent ocular inflammation in B. henselae infections.
- Aggressive and prolonged antimicrobial therapy may be necessary for managing atypical ocular bartonellosis.
- Understanding these rare presentations is crucial for timely diagnosis and effective treatment of ocular infections.
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