Asymptomatic bilateral acute multifocal retinitis in Q fever endocarditis.

A previously healthy cattle farmer in his 40s presented with fever, encephalopathy and hepatitis secondary to acute Coxiella burnetii endocarditis. Dilated funduscopy unexpectedly disclosed bilateral acute multifocal retinitis that was clinically silent yet exhibited inner-retinal hyper-reflectivity on spectral-domain optical coherence tomography. Treatment with doxycycline 100 mg two times per day and weight-adjusted hydroxychloroquine 200 mg three times per day led to complete anatomical and functional recovery by month 10, confirmed by serial imaging. This report emphasises that routine funduscopy should accompany systemic evaluation in Q-fever, because early detection and directed therapy can prevent permanent visual sequelae.