rifampin and Papilledema

BACKGROUND Cat scratch disease (CSD) is a self-limited infection caused by Bartonella henselae that causes lymphadenitis, fevers, skin changes at the inoculation site, headache, nausea, and ocular symptoms. Bartonella neuroretinitis is a form of CSD that presents with ocular symptoms, such as a central scotoma, rather than the typical lymphadenopathy of CSD. Bartonella neuroretinitis is the most common cause of infectious neuroretinitis leading to painless vision loss. Symptoms can mimic the more common optic neuritis, which can lead to under-diagnosis. Early diagnosis of Bartonella neuroretinitis and initiation of appropriate treatment is crucial to prevent vision loss and shorten recovery time. CASE REPORT A 47-year-old man presented to the Emergency Department with nonspecific symptoms of headache, fevers, and visual changes. He was noted to have adopted a cat 2 months prior to presentation. A dilated fundus examination revealed grade 3 optic disc edema with small disc hemorrhages bilaterally without lymphadenopathy, and Bartonella henselae serologies returned positive for the disease. The patient was treated with doxycycline and rifampin at discharge. At his follow-up outpatient ophthalmology visit, the patient had symptomatically improved vision, with dilated fundus examination supporting reduced optic disc edema in the right eye. CONCLUSIONS Early recognition and treatment of Bartonella neuroretinitis is essential to prevent vision loss and shorten recovery time. The current standard of treatment is doxycycline and rifampin for 4 to 6 weeks, and a growing body of literature indicates the supplementation of corticosteroids with these antibiotics.

Topics: Bartonella; Bartonella henselae; Cat-Scratch Disease; Doxycycline; Humans; Papilledema; Retinitis; Rifampin

Topics: Adult; Anti-Bacterial Agents; Bartonella; Cat-Scratch Disease; Doxycycline; Drug Combinations; Eye Infections, Bacterial; Female; Humans; Papilledema; Retinitis; Rifampin; Tomography, Optical Coherence

We report a case of bilateral multifocal retinochoroiditis and bilateral optic disc edema in a patient with cat-scratch disease from Bartonella henselae. The patient initially had negative serologic testing. Repeat testing showed a markedly increased IgG and IgM convalescent titer and the development of a branch retinal artery and vein occlusion. In patients for whom there is a high clinical suspicion of cat-scratch disease, a convalescent titer should be obtained 2-3 weeks following a negative initial result.

Topics: Adult; Anti-Bacterial Agents; Bartonella henselae; Cat-Scratch Disease; Chorioretinitis; Diagnosis, Differential; Doxycycline; Eye Infections, Bacterial; Humans; Immunoglobulin G; Immunoglobulin M; Male; Papilledema; Rifampin; Vision Disorders; Visual Acuity; Vitreous Body

The case is presented of a 29-year-old woman who complained of headache over a period of several days, with loss of visual acuity and pain in her left eye. She had a 3-year history of type 1 diabetes mellitus, and was an immigrant from Ecuador. The funduscopic examination revealed a papilledema. The polymerase chain reaction (PCR) study of the cerebrospinal fluid was positive for Mycobacterium tuberculosis (MTB). She showed a marked improvement after treatment with anti-TB drugs.. About a third of the world's population has a latent infection of MTB, comorbidity between diabetes mellitus and tuberculosis has been reported, particularly in undeveloped countries.

Topics: Adult; Antitubercular Agents; Atrophy; Cerebrospinal Fluid; Developing Countries; Diabetes Mellitus, Type 1; Drug Therapy, Combination; Ecuador; False Negative Reactions; Female; Humans; Immunocompromised Host; Isoniazid; Latent Tuberculosis; Mycobacterium tuberculosis; Ophthalmoscopy; Optic Nerve; Papilledema; Rifampin; Spinal Puncture; Tuberculin Test; Tuberculosis, Meningeal

Tuberculosis is an endemic disease responsible for death and morbidity in developing countries.. A 50-year-old man with no medical history was admitted to the emergency department for meningism associated with fever and confusion. The ophthalmic exam showed a decline in left visual acuity, reduced to light perception, VIth nerve left oculomotor paralysis, ocular fundus demonstrating a yellow tumor located on the posterior segment, measuring 1.5-2mm, papillomatous and prominent in the vitreous cavity. Fluorescein angiography showed a peritumoral choroiditis area, miliary tubercles of the choroid, and sectorial papillomatous edema. Color retinography unmasked inflamed posterior vitreous areas. Echography demonstrated a 4- to 5-mm oval hyperechogeneous and calcified tumor along with hyperechogeneous vitreous areas. Lumbar puncture showed lymphocytic meningitis associated with hyponatremia. The CT scan and MRI demonstrated optic neuritis. The antibiotic therapy was initiated and the outcome was favorable.. This case report shows the importance of systematic ocular fundus in the presence of systemic tuberculosis and outlines the assessment of color retinography to unmask vitreous lesions. It shows the importance of radiological imaging in the semiological study of orbital and cerebral lesions.

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Antitubercular Agents; Calcinosis; Confusion; Diplopia; Drug Therapy, Combination; Fever; Humans; Isoniazid; Magnetic Resonance Imaging; Male; Meningoencephalitis; Middle Aged; Optic Neuritis; Papilledema; Pyrazinamide; Rifampin; Spinal Puncture; Streptomycin; Tuberculoma; Tuberculosis, Meningeal; Ultrasonography

A 35-year-old man presented with a meningeal syndrome and acute onset of visual blurring. Clinical investigations revealed bacterial meningitis with bilateral papillitis and ophthalmoparesis. Serum and cerebrospinal fluid serology confirmed the diagnosis of chronic active neurobrucellosis. Following therapy there was no improvement and he developed optic atrophy. Extensive literature review revealed, one case of bilateral irreversible papillitis resulting from neurobrucellosis. However no cases of neurobrucellosis have been reported with meningitis, irreversible papillitis and ophthalmoparesis. This case demonstrates that in endemic areas, acute meningitis is a potential manifestation of neurobrucellosis and that bilateral irreversible papillitis with ophthalmoparesis can be a potential serious complication.

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Brucella abortus; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Follow-Up Studies; Humans; Male; Meningitis, Bacterial; Ophthalmoplegia; Optic Atrophy; Papilledema; Rifampin; Streptomycin

To report a case of brucellosis with bilateral permanent loss of vision.. Case report.. Bilateral loss of vision developed within two weeks in a young adult with positive Brucella antibodies. There was optic disc swelling with optic neuropathy and serous retinal detachment in both eyes. The patient had chronic active brucellosis confirmed by serum antibody titers (1/640).. This case shows that optic neuropathy may result in severe visual loss in patients with brucellosis.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Glucocorticoids; Humans; Male; Optic Nerve Diseases; Papilledema; Prednisolone; Retinal Detachment; Rifampin; Vision, Low

A 22 year old female presented with sudden onset of uncrossed diplopia at distance, intracranial hypertension, esotropia and was evaluated. Microbiological tests of CSF and sera showed for brucellosis and the patient received therapy for this and her intracranial hypertension. The papilledema, headache, esotropia and diplopia all disappeared after therapy.. Diagnostic tests for brucella must be considered for patients who have divergence palsy and papilledema, especially those living in endemic areas.

Topics: Acetazolamide; Adult; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Ceftriaxone; Central Nervous System Bacterial Infections; Cephalosporins; Cerebrospinal Fluid; Diplopia; Diuretics; Drug Therapy, Combination; Esotropia; Female; Humans; Intracranial Hypertension; Papilledema; Rifampin

The purpose of this case report was to present a rare case of optic disk tubercle. The optic disk edema resolved on antituberculous therapy with recovery of vision. We concluded that visual loss from an optic disk tubercle can be the presenting sign of tuberculosis.

Topics: Adult; Anti-Bacterial Agents; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Fluorescein Angiography; Fundus Oculi; Granuloma; Humans; Isoniazid; Male; Optic Disk; Papilledema; Rifampin; Tuberculosis, Ocular; Vision Disorders

Three patients with verified intracranial tuberculomas are reported. One patient presented with attacks of hydrocephalus initially diagnosed erroneously as migraine, another had multiple tuberculomas and a fourth tuberculoma became apparent during treatment with antituberculous therapy. The third patient presented with a frontal lobe syndrome and the postoperative recovery was complicated by the development of hyperosmolar non-ketotic, non-acidotic diabetic pre-coma. Although there are no pathognomonic symptoms, signs, or radiological appearances of intracranial tuberculomas, a high index of suspicion should always be entertained during the investigation of non-European immigrants.

Topics: Adolescent; Aminosalicylic Acids; Brain Diseases; Dexamethasone; Diabetic Coma; Electroencephalography; Emigration and Immigration; Ethambutol; Female; Headache; Humans; Hydrocephalus; India; Isoniazid; Male; Papilledema; Pyrazinamide; Radionuclide Imaging; Rifampin; Streptomycin; Technetium; Tuberculoma; United Kingdom