Neuroretinitis secondary to dual infection of Toxoplasma gondii and Bartonella hensalae

A 73-year-old lady with underlying diabetes presented with acute loss of central vision in the left eye. Examination revealed visual acuity of 6/60 in the left eye with positive relative afferent pupillary defect and optic disc swelling with macular oedema. Right eye visual acuity was 6/12 with unremarkable findings. Optical coherence tomography (OCT) showed elevated macular with ceacocentral field defect on Humphrey visual field. Connective tissue screening and tubercular screening were negative. Serological screening for Toxoplasma sp and Bartonella sp were positive. She was diagnosed as neuroretinitis secondary to both infections and started on oral azithromycin 500 mg once a day and oral corticosteroid. Her final vision improved to 6/12 with normal optic disc and resolved macular oedema.