Diverse Clinical Signs of Ocular Involvement in Cat Scratch Disease

Abstract

Objectives:To describe ocular manifestations, diagnosis, and treatment of cat scratch disease.Materials and Methods:Clinical records of patients with ocular cat scratch disease were reviewed.Results:Thirteen eyes of 10 patients (7 female, 3 male) with a mean age of 26.9±18.5 years were included. Nine patients had a history of cat contact and had systemic symptoms associated with cat scratch disease 2-90 days prior to the ocular symptoms. Ocular signs were: neuroretinitis in 4 eyes (associated with serous retinal detachment in the inferior quadrant in 1 eye), optic neuropathy in 2 eyes (1 papillitis and optic disc infiltration, 1 optic neuritis), retinal infiltrates in 6 eyes, retinochoroiditis in 1 eye, branch retinal arteriolar occlusion in 3 eyes, and endophthalmitis in 1 eye. Visual acuities at presentation were 1.0 in 7 eyes, 0.3 in 1 eye, ≤0.1 in 4 eyes, and light perception in 1 eye. Bartonella henselae immunoglobulin (Ig) M and/or IgG were positive in all patients. Systemic antibiotic therapy was administered in all patients. Systemic corticosteroid treatment (15-40 mg/day) was added to the therapy in 4 patients, following 5 days of intravenous pulse methylprednisolone in 2 patients. Treatment was ongoing for 1 patient and the mean treatment duration of the other 9 patients was 47±14.5 days. Visual acuities at final visit were 1.0 in 9 eyes, 0.8 in 1 eye, 0.4 in 1 eye, and no light perception in 1 eye.Conclusion:Cat scratch disease may present with different ocular signs and should be considered in the differential diagnosis in patients with such presentations.

Atypical Manifestations of Cat-Scratch Disease, United States, 2005–2014

“…Furthermore, a recent case series of ocular manifestations of cat-scratch disease reported that 9 of 10 patients had symptoms <3 months before showing development of ocular complications and that 3 patients had been originally given misdiagnoses of etiologies other than cat-scratch disease (31). Given that ocular manifestations of cat-scratch disease were most common in our study, increased diagnoses of atypical cat-scratch disease through March could be a sign of delayed diagnoses, particularly for manifestations that are less severe, such as those involving the eye.…”

Update on Bartonella neuroretinitis

“…Many ocular manifestations may be related to CSD, with neuroretinitis and focal retinochoroiditis/retinal infiltrates being the most common clinical forms of ocular CSD 1, 5, 6, 7. Conversely, B. henselae is among the most common causes of neuroretinitis 8, 9…”

A case of Bartonella neuroretinitis with macular star diagnosed by clinical, epidemiological, serological, and molecular data: resolution after initiation of antimicrobial therapy

“…One complication of CSD is Parinaud oculoglandular syndrome, which presents with fever, regional lymphadenopathy, and granulomatous follicular conjunctivitis. Other complications include neuroretinitis, focal retinochoroiditis, iridocyclitis, papillitis, peripapillary angiomatosis, serous retinal detachment, branch retinal arteriolar occlusion, endophthalmitis, myelitis, aseptic meningitis, and encephalitis 8,9 . B. henselae is also one of the etiologic agents of bacillary angiomatosis (the other being B. quintana, a humanspecific pathogen with worldwide distribution transmitted by the human body louse Pediculus humanus humanus).…”