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Objective To report a case of abducens nerve palsy with associated retinal involvement due to rickettsia typhi infection. Material and methods A single case report documented with multimodal imaging. Results A 18-year-old woman with a history of high-grade fever was initially diagnosed with typhoid fever and treated with fluoroquinolone. She presented with a 5-day history of diplopia and headaches. Her best-corrected visual acuity was 20/20 in both eyes. Ocular motility examination showed left lateral gaze restriction. Lancaster test confirmed the presence of left abducens palsy. Fundus examination showed optic disc swelling in both eyes associated with superotemporal retinal hemorrhage and a small retinal infiltrate with retinal hemorrhage in the nasal periphery in the left eye. Magnetic resonance imaging (MRI) of the brain and orbits showed no abnormalities. A diagnosis of rickettsial disease was suspected and the serologic test for Richettsia Typhi was positive. The patient was treated with doxycycline (100 mg every 12 h) for 15 days with complete recovery of the left lateral rectus motility and resolution of optic disc swelling, retinal hemorrhages, and retinal infiltrate. Conclusion Rickettsial disease should be considered in the differential diagnosis of abducens nerve palsy in any patient with unexplained fever from endemic area. Fundus examination may help establish an early diagnosis and to start an appropriate rickettsial treatment.

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Objective: To report a case of abducens nerve palsy with associated retinal involvement due to rickettsia typhi infection Material and methods: A single case report documented with multimodal imagingResults: A 18-year-old woman with a history of high-grade fever was initially diagnosed with typhoid fever and treated with fluoroquinolone. She presented with a 5-day history of diplopia and headaches. Her best-corrected visual acuity was 20/20 in both eyes. Ocular motility examination showed left lateral gaze restriction. Lancaster test confirmed the presence of left abducens palsy. Fundus examination showed optic disc swelling in both eyes associated with superotemporal retinal hemorrhage and a small retinal infiltrate with retinal hemorrhage in the nasal periphery in the left eye. Magnetic resonance imaging (MRI) of the brain and orbits showed no abnormalities. A diagnosis of rickettsial disease was suspected and the serologic test for Richettsia Typhi was positive. The patient was treated with doxycycline (100 mg every 12 h) for 15 days with complete recovery of the left lateral rectus motility and resolution of optic disc swelling, retinal hemorrhages, and retinal infiltrate.Conclusion: Rickettsial disease should be considered in the differential diagnosis of abducens nerve palsy in any patient with unexplained fever from endemic area. Fundus examination may help establish an early diagnosis and to start an appropriate rickettsial treatment.

Purpose Fluorescein angiography (FA) has been the gold standard for the evaluation and management of occlusive retinal vasculitis. Our purpose is to describe swept‐source optical coherence tomography angiography (OCTA) findings in eyes with occlusive retinal vasculitis. Methods This prospective study included 15 patients (25 eyes) diagnosed with occlusive retinal vasculitis involving the posterior pole or the periphery. All patients were evaluated using FA, spectral domain optical coherence tomography, and OCTA. Results The causes of occlusive retinal vasculitis included Behcet disease in 12 patients (21 eyes), ocular tuberculosis in 1 patient (2 eyes), West Nile virus infection in 1 patient (1 eye) and rickettsiosis in one patient (1 eye). OCTA was superior to FA in evaluating perifoveal microvascular changes. It showed in twenty eyes (80%) areas of retinal capillary nonperfusion/hypoperfusion with or without associated rarefied, dilated, or shunting vessels. The deep retinal capillary plexus was more severely affected than the superficial capillary plexus. Conclusions OCTA allowed better evaluation of macular ischemia than FA in eyes with occlusive retinal vasculitis. The deep capillary plexus appeared to be more severely involved than the superficial capillary plexus.