Abderrahim Kaies, Zina Sourour, Khairallah Molka, Ben Amor Hager, Khochtali Sana, Khairallah Moncef
Department of Ophthalmology, Medenine University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia.
Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 5019, Monastir, Tunisia.
J Ophthalmic Inflamm Infect. 2021 Mar 22;11(1):9. doi: 10.1186/s12348-021-00239-1.
To report a case of abducens nerve palsy with associated retinal involvement due to rickettsia typhi infection.
A single case report documented with multimodal imaging.
A 18-year-old woman with a history of high-grade fever was initially diagnosed with typhoid fever and treated with fluoroquinolone. She presented with a 5-day history of diplopia and headaches. Her best-corrected visual acuity was 20/20 in both eyes. Ocular motility examination showed left lateral gaze restriction. Lancaster test confirmed the presence of left abducens palsy. Fundus examination showed optic disc swelling in both eyes associated with superotemporal retinal hemorrhage and a small retinal infiltrate with retinal hemorrhage in the nasal periphery in the left eye. Magnetic resonance imaging (MRI) of the brain and orbits showed no abnormalities. A diagnosis of rickettsial disease was suspected and the serologic test for Richettsia Typhi was positive. The patient was treated with doxycycline (100 mg every 12 h) for 15 days with complete recovery of the left lateral rectus motility and resolution of optic disc swelling, retinal hemorrhages, and retinal infiltrate.
Rickettsial disease should be considered in the differential diagnosis of abducens nerve palsy in any patient with unexplained fever from endemic area. Fundus examination may help establish an early diagnosis and to start an appropriate rickettsial treatment.
报告一例因伤寒立克次体感染导致外展神经麻痹并伴有视网膜受累的病例。
一份通过多模态成像记录的单病例报告。
一名有高热病史的18岁女性最初被诊断为伤寒热并接受氟喹诺酮治疗。她出现了5天的复视和头痛病史。她双眼的最佳矫正视力均为20/20。眼球运动检查显示左侧凝视受限。兰开斯特试验证实存在左侧外展神经麻痹。眼底检查显示双眼视盘肿胀，伴有颞上视网膜出血，左眼鼻侧周边有一小片伴有视网膜出血的视网膜浸润。头颅和眼眶的磁共振成像（MRI）未显示异常。怀疑为立克次体病，伤寒立克次体血清学检测呈阳性。患者接受多西环素（每12小时100毫克）治疗15天，左侧外直肌运动完全恢复，视盘肿胀、视网膜出血和视网膜浸润消退。
对于来自流行地区不明原因发热的任何患者，在鉴别诊断外展神经麻痹时应考虑立克次体病。眼底检查可能有助于早期诊断并开始适当的立克次体治疗。
