Atypical Vitelliform-Like Maculopathy Secondary to Bartonella henselae Neuroretinitis

Abstract

Purpose: To describe an unusual case of Bartonella henselae–associated neuroretinitis complicated by acquired vitelliform-like maculopathy following initial treatment with corticosteroid monotherapy. Methods: A single case was reviewed. Results: A 43-year-old man presented with acute, painless vision loss and central visual haziness in the right eye. Initial treatment with intravenous methylprednisolone and oral prednisone at an outside facility failed to improve visual acuity (VA). Subsequent evaluation at a tertiary care center revealed optic disc edema, macular star exudates, atypical subfoveal vitelliform-like changes on optical coherence tomography, and elevated Bartonella henselae titers consistent with infectious neuroretinitis. The patient was treated with a prolonged course of oral doxycycline, resulting in gradual clinical and structural improvement over 20 weeks, with a final VA of 20/60. Conclusions: This case emphasizes the importance of thorough diagnostic evaluation before initiating treatment for optic disc edema and highlights a potential sequela of treating infectious neuroretinitis with corticosteroid monotherapy.