Mediterranean Spotted Fever Complicated with Thrombosis of the Left Central Retinal Vein: A Case Report and Literature Review

摘要

We describe a case of Mediterranean spotted fever complicated with thrombosis of the left central retinal vein. A 41-year-old woman patient living in the city Scodra was referred to our hospital in October 2017 for high fever 40°C, muscular and articular pains, severe headache, maculopapular rash, chills, photophobia and visual loss in his left eye. Ocular examination showed vision acuity: OD 8/10, OS 2/10. Funduscopic examination complemented with fluorescein angiography showed: optic nerve papilla with clear contours, diffuse hemorrhages in the contest off retinal vein thrombosis, white retinal lesions, vascular sheathing and macular cystoids edema. R. conorii antibodies were identified by ELISA anti Rickettsia conorii IgM, IgG and Weil-Felix Ox-19 test. Investigation of other infective agents and the immunological panel were negative. After treatment with doxycycline 200 mg/day for 10 days vision acuity was OD: 8/10 OS: 6/10;FO: There are less hemorrhages in fluorescein angiograph and OCT showed a reduced macular cystoids edema. Mediterranean spotted fever should be considered in the differential diagnosis of a patient who presents with an acute febrile disease accompanied by maculopapular rash especially in the seasons of spring, summer or autumn.