Bartonella henselae Neuroretinitis: A Rare Coinfection in POEMS Syndrome

Abstract

Bartonella henselae is a recognized cause of neuroretinitis in cat scratch disease. Meanwhile, polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes (POEMS) syndrome with Castleman disease (evidence of lymph node hyperplasia), is a chronic debilitating condition that predisposes to various superimposed infections. B. henselae neuroretinitis implicated in POEMS syndrome has not been reported previously. A 34-year-old asymptomatic man was referred for an eye assessment. Examination showed visual acuity of 6/18 in the right eye and 6/24 in the left eye. On fundus examination, both eyes exhibited typical features of neuroretinitis (optic disc swelling and incomplete macular star). There was otherwise no vitritis or chorioretinitis. Serology for B. henselae revealed high immunoglobulin M (IgM) titer (1:96) indicative of acute disease, and positive immunoglobulin G (IgG) (1:156). He was treated with oral azithromycin for 6 weeks and a short course of oral prednisolone. Subsequently, the visual acuity in both eyes improved with resolution of macular star. However, both optic discs remained swollen.

Keywords: Bartonella henselae neuroretinitis; POEMS syndrome; bilateral disc swelling.

Figure 1

Fundus photography during initial assessment shows bilateral optic disc swelling with disc hemorrhages and incomplete macular star

Figure 2

Macular optical coherence tomography shows presence of subretinal fluid, intraretinal edema, and exudates involving the fovea

Figure 3

Optical coherence tomography of the bilateral optic nerve head shows diffuse optic nerve edema

Figure 4

Humphrey visual field grayscale shows bilateral enlarged blind spot

Figure 5

Fundus photography after completed antibiotic and corticosteroid treatment shows resolution of macular star and disc hemorrhages with persistent bilateral optic disc swelling

Figure 6

Computed tomography scans of the abdomen showing hepatosplenomegaly

Figure 7

Computed tomography scan of the abdomen and pelvis showing multiple sclerotic bony lesions over the spine with ivory vertebral appearance of L1 (white arrow)