BILATERAL NEURORETINITIS SECONDARY TO DUAL INFECTION OF BARTONELLA HENSELAE AND LEPTOSPIRA

Abstract

Background: Bartonella henselae is the most common organism responsible for infective neuroretinitis. Conversely, ocular leptospirosis rarely manifests as neuroretinitis. There is no reported case of neuroretinitis caused by co-infection of both organisms to date.

Case Report: A 33 year old lady presented with painless, progressive blurring of vision of both eyes for 2 weeks. Her ocular examination revealed reduced visual acuity to 6/36 with swollen optic disc and macular star exudates in both eyes. Optical coherence tomography showed subretinal fluid causing local neurosensory retinal detachment at posterior pole. Bartonella serology was positive for both IgM and IgG. In addition, Leptospira IgM was also positive. She was then started on oral Doxycycline 100mg BD for 14 days. After 8 weeks, her visual acuity improved to 6/9 and fundus examination showed resolution of optic disc swelling and macula oedema in both eyes.

Conclusion: Bartonella henselae is a well-known causative organism for infective neuroretinitis. However, the other rare organisms such as Leptospira should be considered especially in tropical countries. Co-infection of both Bartonella henselae and Leptospira can manifest as neuroretinitis.

Key words: Neuroretinitis, Bartonella henselae, Leptospira, dual infection