Relapsing uveitis and optic neuritis due to chronic Q fever

A 56-year-old cattle farmer without a previous medical history presented with a sudden loss of vision in his right eye. Upon examination, his visual acuity was 2/10 P3 in the right eye and 10/10 P2 in the left eye. The intraocular pressure was normal, and the anterior segment was calm and without hyalitis. Ophthalmic fundus and fluorescein angiographic examinations were conducted (figure 1). The Goldmann visual field showed only an enlargement of the blind spot. Biological investigations yielded normal values. As the visual acuity of the right eye improved gradually over 4 months to 8/10 P2, no treatment was prescribed. Figure 1 (A) Right ophthalmic fundus revealing a papillitis that was associated with macular oedema with stellar exudates. (B) Fluorescein angiogram showing papillitis of the right eye that was associated with macular oedema with stellar exudates but did not reveal vasculitis. Two years later, the patient presented with a severe loss of vision in the left eye. Clinical examination determined a visual acuity of 8/10 P2 in the right eye and 3/10 P4 in the left eye and normal intraocular pressure. In the left eye, a slit lamp examination revealed a light Tyndall effect without any synechiae or retrodescemetic precipitates, whereas the anterior segment of the right eye was normal. An ophthalmic fundus examination was also performed (figure 2). No vasculitis was indicated by fluorescein angiography, and the finding of the indocyanine green angiography was also found to be normal. The finding of the intracranial magnetic resonance imaging was normal as well. Serological investigations were repeated, but no evidence of infection with Bartonella henselae , Bartonella quintana or Borrelia burgdorferi was detected with a microimmunofluorescence assay. Because the result of the Treponema pallidum haemagglutination assay was also negative, syphilis was ruled out. The Coxiella burnetii phase 1 antigen (microimmunofluorescence assay)–specific immunoglobulin titres were …