Ocular Bartonellosis with Rapidly Progressive Choroidal Granuloma: Case Report

Ocular bartonellosis most commonly presents as neuroretinitis, whereas choroidal granulomas are rare and poorly characterized. This case highlights a rapidly progressive, tumor-mimicking choroidal granuloma, expanding the clinical spectrum, and highlighting the importance of early recognition.

A 42-year-old woman presented with decreased vision in the left eye and was found to have an elevated chorioretinal lesion with subretinal fluid, concerning for a choroidal neoplasm. Within 1 week, the lesion enlarged with significant visual decline. Serologic testing confirmed Bartonella henselae infection, supported by the presence of cat scratches on the arms and legs, establishing the diagnosis of ocular bartonellosis with choroidal granuloma. The patient was treated with oral doxycycline and a prednisone taper, resulting in rapid visual recovery from 20/200 to 20/20 and complete regression of the lesion.

Bartonella-associated choroidal granulomas may present as rapidly progressive, tumor-mimicking lesions. Recognition of this rare presentation and early treatment can lead to favorable visual outcomes.