IMAGE OF THE MONTH: February 2023

Frosted Branch Plus

Submitted by Matt Starr MD (Mayo Clinic, Rochester, MN); JP Dunn, MD (Uveitis Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA)

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A 13-year-old female presented with gradual bilateral vision loss for one month along with a one-month history of fatigue. Visual acuity was 20/200 OU.

DIAGNOSIS

Bartonella Neuroretinitis with Frosted Branch Angiitis

Discussion

The patient was noted to have a 4-year-old cat at home and on review of systems also had significant fatigue limiting her at school. Extensive workup was only revealing for elevated IgG Bartonella titers. She responded well to an oral steroid taper over 4 months along with a one-month course of doxycycline. Vision returned to 20/20 OU and the subretinal fluid, vasculitis, and disc edema resolved

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