Rickettsial retinitis: acute unilateral vision loss with cystoid macular edema and stellate maculopathy.

PURPOSE: To report on the presentation and treatment of a patient with infectious posterior segment uveitis because of infection with Rickettsia rickettsii. METHODS: Interventional case report. We conducted a retrospective chart review of a 39-year-old man who presented with a history of acute vision loss in his right eye over a 6-day period. Vision at presentation in the involved eye was 2/200, with mild conjunctival injection, trace anterior chamber cell, moderate vitritis, localized retinitis and retinal hemorrhages, and severe macular edema. The left eye had 20/20 vision and was normal on examination. History was notable for a tick bite followed by high fevers, 1 month before presentation, at which time his family physician diagnosed mononucleosis syndrome with low platelets. RESULTS: A serum Rickettsia rickettsii test was positive. He was treated with oral doxycycline followed by corticosteroids. Vision gradually improved to 20/20 with minimal residual metamorphopsia. CONCLUSION: Only ten cases of Rocky Mountain spotted fever-related uveitis have been reported. The current case is unique because of the delayed onset of ophthalmic complications after the tick bite, its unilateral nature, dramatic improvement in acuity after treatment, and lack of associated rash.

Retinal vascular anomaly in sturge-weber syndrome.

PURPOSE: We report a unique case of a 7-year-old girl who presented with an unusual combination of findings, including facial hemangioma, choroidal hemangioma, and retinal vascular anomaly. METHODS: Case report and literature review. RESULTS: Examination revealed a hemangioma on the right midface. The acuity was 20/200 in the affected eye. Enlarged episcleral vessels were present. There was a large choroidal hemangioma measuring 4.8 mm in thickness underlying the macula and large dilated white retinal vessels extending to a partially involuted tumor in the periphery. Fluorescein angiography confirmed perfusion of the abnormal retinal vessels, and magnetic resonance imaging showed enhancement consistent with choroidal hemangioma with no other intracranial abnormalities. No other abnormalities were noted on physical examination. CONCLUSION: Neurocutaneous syndromes including Sturge-Weber, Parkes Weber, and Klippel-Trenaunay may show significant degrees of overlapping findings. This case is unique in that this patient presented with both choroidal and retinal tumors as part of Sturge-Weber syndrome with a facial hemangioma.