# Post-fever Retinitis With a Positive Weil-Felix Test: A Study From a Tertiary Center in South India

## TL;DR

This study reports cases of post-fever retinitis linked to rickettsial infections in South India, showing improvement with treatment.

## Contribution

The study is the first to report post-fever retinitis due to rickettsia in South India.

## Key findings

- Nine patients with post-fever retinitis and positive Weil-Felix test showed significant visual improvement after treatment.
- OCT findings revealed hyperreflectivity and inner retinal disorganization in affected areas.
- All patients had typical retinitis patches and retinal hemorrhages that resolved with doxycycline and prednisolone.

## Abstract

Background

Post-fever retinitis (PFR) is reported two to six weeks after fever and affects one or both eyes. Rickettsial fever is one of the most common causes of PFR. This study aimed to report the clinical features and treatment outcomes of PFR cases with a positive Weil-Felix test.

Methodology

In this study, we collected demographic data, fever details, eye symptoms, ocular examination findings, optical coherence tomography (OCT) and fundus fluorescein angiography findings, laboratory findings, and length of follow-up of consecutive PFR cases with a positive Weil-Felix test. All cases were treated with oral doxycycline and prednisolone. Final best-corrected visual acuity (BCVA) and ocular examination findings were recorded. Visual field examination and follow-up OCT results were noted if available.

Results

A total of nine patients (eight males) with a mean age of 39.1 years with fever before ocular symptoms and positive Weil-Felix test were included. Six patients had bilateral disease. The mean initial and final BCVA in the affected eyes was 1.16 and 0.35 logMAR units, respectively (p < 0001). All 15 eyes had typical white retinitis patches and retinal hemorrhages which resolved after treatment. OCT showed hyperreflectivity and inner retinal disorganization over retinitis patches. White subretinal lines were noted in three patients and retinal nerve fiber bundle defect with corresponding visual field defect was seen in one eye.

Conclusions

In this study, PFR due to rickettsia infections has been reported from our region for the first time. Hence, eye specialists in the region should be aware of this entity.