A Rare Case of Retinal Artery Occlusion in the Context of Mediterranean Spotted Fever
A 55-year-old healthy Caucasian female with no history of ocular disease was observed in the emergency department with fever, myalgia, nasal congestion with 3 days of evolution, and a generalized rash for 1 day. She had contact with dogs. Physical examination revealed a cooperating and well-oriented patient with stable vital parameters and a tympanic temperature of 38.2°C. There was a maculopapular rash on the upper limbs, abdomen, and the dorsal region. A tache noir, a small crust surrounded by a violet halo, was visible in the region of the left thigh. There were no meningeal signs and no cardiorespiratory or abdominal changes. Serology for R. conorii was positive with an IgM titer of 1/320. Autoimmune and thrombophilia studies were negative. Hypercholesterolemia and systemic hypertension were excluded. The patient was admitted to our department and therapy with oral doxycycline 100 mg every 12 h was initiated. Oral doxycycline was given for 10 days.\nOn the first day of hospitalization, the patient reported decreased visual acuity (VA) of the right eye (RE). A CT scan was performed which was normal. No ophthalmologic examination was requested.\nThere was a systemic improvement and the patient was discharged after 6 days. Five days thereafter, the patient returned to the emergency room with complaints of worsening of RE VA. Observation revealed an RE VA of 20/100 and there was a superior temporal artery branch occlusion with perivascular sheathing in the ocular fundus as well as cotton wool spots and edema (fig. ). The retinal edema affected the macular region (fig. ). Campimetric examination revealed an inferior nasal scotoma, consistent with fundus lesions (fig. ).\nIntravitreal injection of triamcinolone acetonide 3.2 mg/0.08 ml was given only once and showed significant improvement of the retinal edema and a recovery of RE VA to 20/25 after 1 month. The vascular sheathing and the occlusion persisted (fig. ), and so did the corresponding scotoma in the visual field.\nThe total follow-up period is 1 year. No ocular side effects related to intravitreal triamcinolone were detected.