OCULAR BARTONELLOSIS PRESENTING WITH FOCAL CHOROIDITIS, FOCAL RETINITIS, BRANCH RETINAL ARTERY OCCLUSION, AND PARACENTRAL ACUTE MIDDLE MACULOPATHY: LONGITUDINAL MULTIMODAL IMAGING ANALYSIS.

BACKGROUND/PURPOSE: To report an atypical case of ocular bartonellosis evaluated longitudinally with multimodal imaging and review the literature on the less common posterior segment manifestations of bartonella infection. METHODS: Case report and review of the literature. RESULTS: A 26-year-old man presented with focal choroiditis in the right eye and focal retinitis, a branch retinal artery occlusion, and paracentral acute middle maculopathy in the left eye after a systemic prodrome including headache and lymphadenopathy. Serologic testing revealed positive bartonella immunoglobulin G with a titer of 1:512. The patient was diagnosed with ocular bartonellosis infection and started on systemic doxycycline. The posterior segment findings resolved over the follow-up period, and their resolution was documented with optical coherence tomography. CONCLUSION: Neuroretinitis is the classic ocular finding in cat scratch disease, but less common presenting findings may include focal choroiditis, retinitis, and branch retinal artery occlusion. To the best of our knowledge, this is the first report of paracentral acute middle maculopathy secondary to a retinitis-associated branch retinal artery occlusion as a presenting sign in ocular bartonellosis.

Monitoring and Surveillance of Hemodialysis Vascular Access Using StenTec and Physical Exam.

Hemodialysis vascular access surveillance for hemodynamically significant stenosis can be a challenge because no universal gold standard exists. The StenTec Gauge measures static intra-access peak pressure and graphically displays the ratio of this pressure to systemic systolic (peak) arterial pressure (PIA ratio). In combination with careful physical exam (PE), the StenTec Gauge is an acceptable and cost-effective way of detecting hemodynamically significant stenosis in arteriovenous fistulas (AVF) or grafts (AVG). In a selected population of 21 hemodialysis patients with mature arteriovenous access, a StenTec reading and physical examination was measured on a weekly basis. Interventional procedures for suspected access dysfunction were performed if there was a greater than 25% increase of the PIA ratio from baseline in two consecutive readings, along with correlating clinical suspicion from physical examination findings. StenTec independently had a sensitivity of 56% and a specificity of 99% in detecting clinically significant stenosis. PE alone had a sensitivity of 89% and a specificity of 100%. StenTec combined with PE had a sensitivity of 100% and a specificity of 99% for predicting hemodynamically significant stenosis. StenTec detected 4 of 10 patients who had a PIA ratio value of ≥0.5, which correlates with current National Kidney Foundation Disease Outcomes Quality Initiative (KDOQI) criteria for mean intra-access pressure ratios indicating a clinically significant outflow stenosis. PE predicted 9 of 10 patients with stenosis, and the combination of StenTec and PE predicted all 10 patients with clinically significant stenosis using the KDOQI criteria for PIA ratio. Hemodynamically significant access stenosis can be detected with excellent accuracy using both StenTec and PE measurements combined for monitoring and surveillance methods.