A 32-year-old White man presented with multiple paracentral scotomata in each eye. Examination revealed mild vitreous cell, segmental sheathing of the retinal veins, and
inflammation of the paravenous retina in each eye. Multimodal imaging, including optical coherence tomography as well as widefield fundus autofluorescence,
fluorescein angiography, and
indocyanine green angiography, was consistent with bilateral, segmental
retinal periphlebitis with paravenous
inflammation and retinochoroidal
scarring. Serology showed elevated B. henselae antibody titers, but was otherwise unrevealing, and the patient was diagnosed with presumed B. henselae-associated ocular
inflammation. Treatment with systemic
doxycycline (100 mg PO BID) for four weeks improved the patient's symptoms and
posterior uveitis. However, after an asymptomatic period of nearly one year, his bilateral pericentral scotomata recurred and posterior segment examination confirmed new foci of
retinal periphlebitis in each eye. Re-treatment with
doxycycline (100 mg PO BID) for four weeks again yielded improvement, but one month after completing his
antibiotic course, his visual symptoms recurred, and we observed additional areas of
periphlebitis and paravenous
retinitis with associated branch
retinal vein occlusions in each eye. This time a dual
antibiotic regimen of
doxycycline (100 mg PO BID) and
rifampin (300 mg PO BID) was administered for three months, with improvement. Over the next eight years, the patient experienced no further disease relapse, and the previous sites of
retinal periphlebitis eventually developed perivenous
fibrosis with paravenous retinochoroidal
scarring.
Conclusion: