Rocky Mountain Spotted Fever as a cause of macular star figure.
An 86-year-old woman with a history of tick bites in the previous months developed subnormal visual acuity in both eyes, keratic precipitates, anterior chamber and vitreous cells, optic disc edema, retinal hemorrhages, and retinal arteriolar sheathing. She had no fever or skin rash. Three weeks later, binocular macular star figures appeared. Brain imaging was negative; cerebrospinal fluid disclosed a lymphocytic pleocytosis and elevated protein. The serum Rickettsia rickettsii antibody test was markedly positive, establishing a diagnosis of Rocky Mountain Spotted Fever (RMSF) as the cause of the ophthalmic findings. Despite treatment with oral doxycycline, these findings improved only modestly. Although neuroretinitis has been previously described in RMSF, macular star has not been documented.
Vaphiades
Michael S
MS
UAB Department of Ophthalmology, Suite 601, 700 South 18th Street, Birmingham, AL 35233, USA. vaphiades@eyes.uab.edu
D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004318:Doxycycline / Q000008:administration & dosage; D004487:Edema / Q000382:microbiology; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000473:pathology; D009901:Optic Nerve Diseases / Q000382:microbiology; D012164:Retinal Diseases / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology; D012173:Retinitis / Q000382:microbiology; D012373:Rocky Mountain Spotted Fever / Q000150:complications* / Q000188:drug therapy; D014794:Visual Fields
D000900:Anti-Bacterial Agents; D004318:Doxycycline