A 21-year-old Caucasian female presented to the Wills Retina Service with a three-day history of bilateral decreased vision, worse in the right eye. She denied any flashes, floaters, or associated complaints. Three weeks prior she had an episode of sinusitis treated with amoxicillin for 10 days as an outpatient. One week prior she developed high fevers to 103 F, severe headache, retrobulbar ache, neck pain and stiffness, nausea and vomiting, confusion, diffuse myalgias and a bilateral lower extremity nontender papular erythematous rash. At a community emergency department she was rehydrated, given Benadryl, and a lumbar puncture was performed, which ruled out bacterial meningitis. She was discharged on azithromycin and her systemic symptoms and fever resolved prior to her presentation to the Wills Retina service.
Past ocular history was unremarkable and past medical history was significant for migraine headache and Lyme disease, which was previously treated. Immunizations were up to date. Her only medication was an oral contraceptive. Family history was notable for a maternal grandmother with multiple sclerosis. She denied any sick contacts, recent travel and bug or animal bites. She has two indoor dogs and cats and two indoor cats and works at a veterinary clinic. She lives in a university dormitory. She denied any history of sexually transmitted infections, or alcohol or IV drug use.
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