Acute multifocal retinitis: a retrospective review of 35 cases

Abstract

BackgroundAcute multifocal retinitis is a rare condition that has been considered to be often idiopathic. The purpose of this study was to analyze clinical features and causes of acute multifocal retinitis.ResultsThis study is a retrospective review of the charts of 35 patients with acute multifocal retinitis. Patients with three or more retinal lesions in at least one eye, with at least one lesion of less than 500 μm in size were included. All patients had complete ophthalmological examination, fundus photography, and fluorescein angiography. Twelve patients (34.3%) had optical coherence tomography. An extensive work-up was performed including a detailed comprehensive medical history, examination by an internist and an infectious disease specialist, a chest X-ray, Mantoux test, and laboratory tests for syphilis, human immunodeficiency virus, Bartonella, and Rickettsia. Of the 35 patients, 25 (71.4%) had bilateral involvement and 10 (28.6%) had unilateral involvement (total number of eyes: 60). Mean best-corrected visual acuity (BCVA) was 20/25 (range, 20/1000–20/20). Retinal lesions ranged from 3 to more than 20 in number in at least 1 eye, and from 150 to 1500 μm in size. Associated findings included mild anterior chamber inflammation in 5 eyes (8.3%), mild vitritis in 46 eyes (76.7%), optic disc swelling in 9 eyes (15%), macular star in 4 eyes (6.7%), exudative retinal detachment in 6 eyes (10%), and branch retinal artery occlusion in 6 eyes (10%). Acute multifocal retinitis was found to be caused by Rickettsia conorii infection in 20 patients (57.1%), Rickettsia typhi infection in 4 patients (11.4%), cat-scratch disease in 8 patients (22.9%), and syphilis in 1 patient (2.9%). It was idiopathic in two patients (5.7%). Retinal lesions resolved without scarring in 3 to 12 weeks in all but three eyes (5%), in which residual retinal pigment epithelial changes were noted.ConclusionRickettsial disease was the most common cause of acute multifocal retinitis. Other identified causes included cat-scratch disease and syphilis, and a very small subset of patients was diagnosed with idiopathic multifocal retinitis.

Acute multifocal retinitis in a patient with Q fever (Coxiella Burnetii infection) with endocarditis

“…AMR, previously termed acute multifocal inner retinitis, has been considered to be often idiopathic, but several infectious etiologies have been recognized including cat scratch disease, rickettsial infection, and syphilis [ 6 – 9 ]. Recent data from Tunisia show rickettsial disease, including rickettsia conorii and rickettsia typhi, to be the most common cause of AMR [ 10 ]. In the present case, serological testing showed negative results for rickettsial infection and also for cat scratch disease and syphilis.…”

Acute multifocal retinitis in a patient with Q fever (Coxiella Burnetii infection) with endocarditis

“…AMR, previously termed acute multifocal inner retinitis, has been considered to be often idiopathic, but several infectious etiologies have been recognized including cat scratch disease, rickettsial infection, and syphilis [6][7][8][9]. Recent data from Tunisia show rickettsial disease, including rickettsia conorii and rickettsia typhi, to be the most common cause of AMR [10]. In the present case, serological testing showed negative results for rickettsial infection and also for cat scratch disease and syphilis.…”

Rickettsial disease: An underestimated cause of posterior uveitis

“…Bilateral or rarely unilateral multifocal or unifocal white retinal lesions have been reported to be a common and typical clinical finding in rickettsial disease including MSF, RMSF, and murine typhus. [ 9 10 11 12 13 14 ] Recent data show that rickettsial disease was the most common cause of acute multifocal retinitis associated with febrile illness, accounting for 68.5% of cases[ 11 ] [ Figure 1 ]. Rickettsial acute multifocal retinitis typically presents in the form of white retinal infiltrates involving the inner retinal layers, located adjacent to retinal vessels, and varying in number, size, and location.…”

“…A localized retinal nerve fiber layer defect and focal retinal thinning are typically seen on OCT as sequelae of retinal infiltrate. [ 11 ]…”