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Images in Neurology
June 2001

Macular Star in Neuroretinitis

Arch Neurol. 2001;58(6):1008-1009. doi:10.1001/archneur.58.6.1008

A 31-year-old healthy woman suddenly noticed a black spot in the central vision of her left eye. She denied pain on eye movements and had no systemic or neurological complaints. Visual acuity measured 20/20 in the right eye and counting fingers in the left eye. Visual field testing showed a large central scotoma in the left eye and a left relative afferent pupillary defect. The fundus of the right eye was normal. The left eye demonstrated sectoral optic nerve edema with an infiltrate and elevation of the macula (Figure 1). The patient recalled handling several kittens 3 weeks earlier. Indirect fluorescent antibody assay was positive for Bartonella (formerly Rochalimaea) henselae (IgM, 1:128; IgG, 1:1024). A 5-day course of azithromycin was prescribed. Eight days later, the patient's vision continued to be limited to counting fingers in the left eye; however, the examination then revealed a macular star (Figure 2). During the next 6 weeks, the macular star and optic nerve edema diminished, and the patient's visual acuity improved to 20/100 in the left eye. Approximately 5 months after the initial examination, her acuity was 20/25 in the left eye, and there was no detectable visual field defect.

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