A Patient with Headache and Vision Loss in the Right Eye

Examination showed optic-disk edema with macular and subretinal fluid, visual acuity of 20/250 in the right eye with abnormal color discrimination, and a right relative afferent pupillary defect. Imaging revealed liver lesions and lymphadenopathy. He was also found to have a new HIV diagnosis (with a CD4 count of 315/μl) and lymphocytic pleocytosis of his cerebral spinal fluid. Subsequent ophthalmologic examination showed development of a macular star (Figure 1); he was thus tested for and diagnosed with neuroretinitis due to Bartonella henselae.