Page 50 - Read Online

Page 6 of 7 Montabone et al. Neuroimmunol Neuroinflammation 2019;6:7 I http://dx.doi.org/10.20517/2347-8659.2019.09

[20]
greater for IgG (88%-98%) compared to IgM (50%-62%) . False positives due to cross-reaction are highly
improbable being about 2%-5% for Epstein Barr/Cytomegalovirus, and 20%-50% for Coxiella burnetii/
[21]
non-henselae bartonellosis (very rare in our country) . IgM presence allows to date back infection to the
previous 3 months, whereas IgG remains detectable in the 25% of patients one year later.

Finally, we observed full clinical and instrumental recovery after specific antibiotic and steroid therapy. In
a retrospective study on 74 CSD patients with ocular disease, 44 were treated with antibiotics alone, 17 with
antibiotics and steroids (both intravenous high dose metil-prednisolone or oral prednisone), 2 with steroids
alone and 11 patients didn’t receive any treatment. Visual acuity improvement occurred in 50% of the
[10]
patients treated with antibiotics alone, and in 87.5% treated with both antibiotics and corticosteroids .
The combination of doxycycline and steroids shorten the course of disease and accelerate visual recovery
[22]
compared to natural history of illness in our case . No side effects were reported.
CSD neuroretinitis is a rare clinical condition that must be considered in young patient with rapidly
progressive unilateral visual loss. It requires a prompt neuro-ophthalmological evaluation in order to
establish the correct diagnosis and start an early specific treatment.

DECLARATIONS
Authors’ contributions
Made substantial contributions to realization of this case report: Montabone C, Vecchio D, Vujosevic S
Reviewed the case as well as the manuscript, providing substantial contribution to discussion and
conclusion: De Cillà S, Cantello R

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
The patient gave written informed consent.

Consent for publication
The patient gave written informed consent for publication. All clinical information submitted is anonymous
and the patient is not recognizable from the iconographic material.

Copyright
© The Author(s) 2019.

REFERENCES
1. Purvin V, Sundaram S, Kawasaki A. Neuroretinitis: review of the literature and new observations. J Neuroophtalmol 2011;31:58-68.
2. Touitou V, LeHoang P. Diagnostic approach in optic neuropathy. Rev Neurol (Paris) 2012;168:691-6.
3. Kahloun R, Abroug N, Ksiaa I, Mahmoud A, Zeghidi H, et al. Infectious optic neuropathies: a clinical update. Eye Brain 2015;7:59-81.
4. Mabra D, Yeh S, Shantha JG. Ocular manifestations of bartonellosis. Curr Opin Ophtalmol 2018;29:582-7.
5. Cunningham ET, Kochner JE. Ocular bartonellosis. Am J Opthalmol 2000;130: 340-9.
6. Murakami K, Tsukahara M, Tsuneoka H, Iino H, Ishida C, et al. Cat scratch disease: analysis of 130 sieropositive cases. J Infect