Patient presented with sudden onset decreased vision in his left eye. Fundus photos show the progression of macular star at presentation (Figure 1), 1 week later (Figure 2), and three weeks later (Figure 3). Ocular Coherence Tomography at these same visits shows significant outer retinal fluid in the nasal macula reaching the fovea center. The OCTs show gradual resolution of the intraretinal fluid and deposition of hyper-reflective material in the outer plexiform layer at the fovea, called the nerve fiber layer of Henle, and fluid here gives the classic appearance of a "macular star". The patient was serum positive for Bartonella henselae (Cat Scratch Disease).
34-year-old female diagnosed with Bartonella neuroretinitis and cilioretinal artery occlusion of the left eye. She presented with a "gray spot" in her vision. Exam revealed an RAPD OS. Photos demonstrate appearance on presentation, 1 week, 3 weeks, 4 weeks, and 8 weeks after presentation. Patient was treated with oral Azithromycin at 5 weeks after presentation when positive bartonella serology returned.
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Related Case: Cat-Scratch neuroretinitis (Ocular bartonellosis)
Related Case: Recurrent Neuroretintitis
Related Atlas Entry: Diffuse Unilateral Subacute Neuroretinitis (DUSN)