To report a case of abducens nerve palsy with associated retinal involvement due to rickettsia typhi infection. A single case report documented with multimodal imaging. 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. 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.

中文翻译：

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继发于立克次体伤寒感染后引起神经麻痹及相关的视网膜受累

报告一例因伤寒立克次氏体感染引起的伴有视网膜受累的外展神经麻痹。用多模式成像记录的单个病例报告。最初有一名高烧病史的18岁妇女最初被诊断为伤寒，并接受氟喹诺酮治疗。她出现了5天的复视和头痛病史。她的最佳矫正视力在两只眼睛中均为20/20。眼动检查显示左侧视线受限。兰开斯特试验证实存在左外展神经麻痹。眼底检查显示，双眼视盘红肿与颞上颞部视网膜出血有关，左眼鼻周部有少量视网膜浸润伴视网膜出血。大脑和眼眶的磁共振成像（MRI）没有发现异常。怀疑诊断为立克次体病，伤寒立克次体的血清学检查为阳性。该患者接受强力霉素（每12小时100 mg）治疗15天，完全恢复了左侧直肌运动，并消除了视盘肿胀，视网膜出血和视网膜浸润。对于地方性原因不明原因发烧的任何患者，在鉴别诊断外展神经麻痹时应考虑使用立克次体病。眼底检查可能有助于建立早期诊断并开始适当的立治疗。和视网膜浸润。对于地方性原因不明原因发烧的任何患者，在鉴别诊断外展神经麻痹时应考虑使用立克次体病。眼底检查可能有助于建立早期诊断并开始适当的立治疗。和视网膜浸润。对于地方性原因不明原因发烧的任何患者，在鉴别诊断外展神经麻痹时应考虑使用立克次体病。眼底检查可能有助于建立早期诊断并开始适当的立治疗。