Ocular leptospirosis as the sole clinical manifestation in a pediatric patient: an atypical case.

OBJECTIVE: To describe an atypical presentation of ocular leptospirosis in a pediatric patient without systemic symptoms, highlighting its diagnostic challenges and therapeutic approach. CASE PRESENTATION: A 9-year-old previously healthy girl presented with unilateral papillitis and vitritis, progressing to 360º retinal vasculitis as the sole manifestation of subclinical leptospirosis. Serology was positive for Leptospira spp. (IgM and IgG), although PCR testing in aqueous humor and urine was negative. The condition was interpreted as a post-infectious immune-mediated response. Treatment included systemic corticosteroids, intravenous ceftriaxone, and intravitreal triamcinolone, resulting in complete anatomical and visual recovery. DISCUSSION: Ocular leptospirosis can appear as an isolated manifestation in the immune phase of infection, even in the absence of general symptoms or epidemiological evidence. Pediatric cases are rare and often underdiagnosed due to the negative microbiological tests in late stages. This case also highlights the importance of considering environmental exposures, such as flooding, as potential risk factors. CONCLUSION: This case underlines the need to include leptospirosis in the differential diagnosis of posterior uveitis and papillitis of unknown origin in children. Early multidisciplinary management and appropriate immunomodulatory treatment can prevent permanent visual sequelae.