# Bilateral acute multifocal retinitis and retinal vasculitis secondary to Rickettsia typhi infection

## TL;DR

A 37-year-old woman developed eye inflammation and retinal lesions linked to a Rickettsia typhi infection, which improved with doxycycline treatment.

## Contribution

This case report highlights Rickettsia typhi as a rare cause of acute multifocal retinitis and retinal vasculitis.

## Key findings

- The patient's retinal lesions were confined to inner/middle retinal layers and showed late leakage on fluorescein angiography.
- Diagnosis of Rickettsia typhi was confirmed, and symptoms resolved with doxycycline treatment.

## Abstract

To describe a case of acute multifocal retinitis (AMR) and retinal vasculitis associated with Rickettsia typhi.

Case report.

A 37-year-old previously healthy female presented with acute bilateral panuveitis that was preceded by a febrile illness with pneumonitis and transaminitis. On exam she had bilateral multifocal small white retinal lesions, vascular sheathing, and hemorrhages. The retinal lesions, which appeared consistent with infiltrates and/or ischemia, were confined within the inner or middle retinal layers on optical coherence tomography (OCT) and corresponded to late leakage on fluorescein angiography (FA). There was no evidence of choroidal involvement on indocyanine green angiography (ICGA). Based on the imaging findings and history, the diagnosis of AMR with associated small vessel retinal vasculitis was made and the patient was started empirically on doxycycline. Workup was positive for R. typhi. At follow-up, there was resolution of visual symptoms and nearly all retinal lesions.

Rickettsial disease should be highly suspected in a patient with AMR and occlusive small vessel vasculitis. Retinal lesions may be either infiltrative or ischemic in nature. Diagnosis, which can be aided by multimodal retinal imaging, is essential for prompt initiation of appropriate antibiotic therapy.