Central scotoma in a young adult male with flu like symptoms

Purpose: To briefly discuss a young, otherwise healthy Caucasian male who presented to an emergency department with the complaint of acute scotoma. Observations: External ocular and anterior segment examination were unremarkable. A dilated fundus examination of the right eye showed a wedge-shaped area of retinal whitening and cotton wool spots in the inferior macula between the optic nerve head and fovea. Conclusions and Importance: After a thorough work up including a limited coagulopathy screening and rheumatologic and infectious panels, it was determined the most likely cause of presentation was systemic Bartonella infection contracted from the patient’s pet cat. The patient was treated with oral doxycycline 100 mg BID for 4 weeks and maintained stable vision on subsequent follow ups with no recurrent arterial occlusions. We hope this report provides clinicians with an insight into an uncommon ophthalmologic presentation of Bartonella henselae infection, as well as a reasonable template for successful treatment if such a case is encountered.