Multifocal Inner Retinitis as a Distinctive Finding of Mediterranean Spotted Fever: A Case Report

Abstract

Aims: To highlight the role of characteristic multifocal inner retinitis identified by multimodal imaging as a crucial diagnostic marker for Mediterranean Spotted Fever (MSF), particularly when early serology is negative. Case Study: A 45-year-old male presented with a one-week history of febrile rash and acute bilateral vision loss. Clinical examination revealed a maculopapular rash but no inoculation eschar. Ophthalmic evaluation, including SS-OCT and FA, demonstrated bilateral multifocal inner retinitis, vasculitis, and macular edema. Despite initial negative Rickettsia conorii serology, treatment with doxycycline and corticosteroids was initiated based on the typical ocular pattern. Discussion: Multimodal imaging localized the retinitis exclusively to the inner retinal layers in close proximity to the retinal vessels, mirroring the known angiotropism of Rickettsia conorii. This precise anatomical finding provided a critical diagnostic marker during the acute phase of infection, bridging the window prior to seroconversion. Conclusion: Multifocal inner retinitis is a distinctive hallmark of the acute phase of Mediterranean Spotted Fever. Systematic fundoscopic examination, supported by multimodal imaging, should be part of the routine evaluation for patients presenting with febrile rash in endemic areas.