背景:报告1例由伤寒立克次体引起的视网膜脉络膜炎在没有葡萄膜炎的患者中的异常表现。
方法:在这种情况下,我们描述了一个24岁的男性士兵,以前没有眼病,他因双侧视网膜脉络膜炎和玻璃体炎被转诊到我们的眼科。2023年6月,患者最初出现右眼中央旁暗点持续7天,左眼分散黑斑2天。在这些眼部症状之前,他经历了两周的发烧,头痛,盗汗,和快速减肥10公斤。短暂的皮疹覆盖了他的身体。他的母亲有反复眼部炎症的病史。体格检查显示角膜下周边双侧角膜沉积,1+前玻璃体细胞,小视网膜病变和轻度视盘抬高。荧光素血管造影显示轻度椎间盘高度荧光,OCT上临床可见的圆形点状病变显示内部视网膜过度反射病变,深度至外部丛状层可能提示视网膜炎病变。实验室检查正常,除了血小板增多,ESR升高,肝酶和ACE水平,伤寒立克次体血清学检测呈阳性。风湿病和传染病咨询排除了自身免疫性疾病,确认伤寒立克次体感染。治疗包括全身多西环素和泼尼松,随着视力的提高,眼部症状,OCT异常和炎症的决议。泼尼松停药,两个月后,临床上观察到额外的改善,OCT上保留的视网膜结构。
结论:本研究探讨了视网膜脉络膜炎作为伤寒立克次体的一种罕见眼部表现,中东不寻常的感染。以前报道的眼部表现包括结膜炎,玻璃体炎,感染后视神经病变和少数葡萄膜炎。眼部症状伴随全身性疾病,强调临床医生需要提高认识。诊断依赖于血清转换,荧光血管造影和OCT辅助评估。建议经验性多西环素和全身性皮质类固醇治疗。眼部症状在两个月内缓解。意识到这些眼部表现对于及时诊断和管理至关重要。需要进一步的研究来充分了解鼠斑疹伤寒的这一方面。
BACKGROUND: To report a case of unusual presentation of retinochoroiditis caused by Rickettsia typhi in a patient without prior uveitis.
METHODS: In this case, we describe a 24-year-old male soldier with no previous eye disease, who was referred to our ophthalmology department due to bilateral retinochoroiditis and vitritis. The patient initially presented with a paracentral scotoma in his right eye persisting for 7 days and scattered dark spots in his left eye for 2 days in June 2023. Preceding these ocular symptoms, he experienced a two-week episode of fever, headaches, night sweats, and rapid weight loss of 10 kg. A transient rash covered his body briefly. His mother had a history of recurrent eye inflammation. Physical examination revealed bilateral keratic precipitates on the lower corneal periphery, 1 + anterior vitreous cells, small retinal lesions and mild optic discs elevation. Fluorescein angiography indicated mild discs hyperfluorescence, and the clinically visible round punctate lesions on OCT showed inner retinal hyper-reflective lesion with a depth till outer plexiform layer possibly suggestive of a retinitis lesion. Laboratory tests were normal except thrombocytosis, elevated ESR, liver enzymes and ACE levels, with positive Rickettsia typhi serology tests. Rheumatology and infectious disease consultations ruled out autoimmune diseases, confirming Rickettsia typhi infection. Treatment included systemic doxycycline and prednisone, with improvement of visual acuity, ocular symptoms, OCT abnormalities and resolution of inflammation. Prednisone was discontinued, and after two months, additional improvement was seen clinically, with preserved retinal structures on OCT.
CONCLUSIONS: This study explores retinochoroiditis as a rare ocular presentation of Rickettsia typhi, an unusual infection in the Middle East. Previously reported ocular manifestations include conjunctivitis, vitritis, post infectious optic neuropathy and a few cases of uveitis. Ocular symptoms followed systemic illness, highlighting the need for awareness among clinicians. Diagnosis relies on seroconversion, with fluorescein angiography and OCT aiding in assessment. Empiric doxycycline and systemic corticosteroid therapy is recommended. Ocular symptoms resolved in two months. Awareness of these ocular manifestations is essential for timely diagnosis and management. Further research is needed to fully understand this aspect of murine typhus.