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M.M. Teeter, M. Landers; Neuroretinitis in the Setting of Multiple Infectious Processes: A Case Report . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5564.
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Purpose: The presentation of a case of neuroretinitis in the setting of multiple infectious processes. Methods: A previously healthy 27 year old woman presented with sudden, painful, unilateral vision loss. The patient initially had a complete eye exam, MRI, and an extensive laboratory evaluation. The patient was followed with serial exams. Within two weeks, she developed additional symptoms of headache and neck stiffness. An eye exam, MRI, lumbar puncture, and laboratory evaluation were undertaken. Results: The patient was initially found to have hand motion vision, severe optic disc edema, and a macular star in the effected eye. The MRI and laboratory evaluation were normal. The subsequent evaluation, following the onset of headache, revealed aseptic meningitis. The cerebrospinal fluid was positive for varicella–zoster by PCR. Bartonella serology later returned positive. Empiric therapy for both infectious agents had been initiated. The patient has shown significant improvement in her eye exam and her vision. Conclusions: The diagnosis had been debated prior to the return of the positive bartonella serology. It was thought that the neuroretinitis and meningitis were each due to varicella–zoster, rather than two separate infections. In light of the clinical findings and the laboratory results, the patient most likely had concomitant bartonella neuroretinitis and varicalla–zoster meningitis.
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