Parinaud’s Oculoglandular Syndrome: A Case in an Adult with Flea-Borne Typhus and a Review

Abstract

Parinaud’s oculoglandular syndrome (POGS) is defined as unilateral granulomatous conjunctivitis and facial lymphadenopathy. The aims of the current study are to describe a case of POGS with uveitis due to flea-borne typhus (FBT) and to present a diagnostic and therapeutic approach to POGS. The patient, a 38-year old man, presented with persistent unilateral eye pain, fever, rash, preauricular and submandibular lymphadenopathy, and laboratory findings of FBT: hyponatremia, elevated transaminase and lactate dehydrogenase levels, thrombocytopenia, and hypoalbuminemia. His condition rapidly improved after starting doxycycline. Soon after hospitalization, he was diagnosed with uveitis, which responded to topical prednisolone. To derive a diagnostic and empiric therapeutic approach to POGS, we reviewed the cases of POGS from its various causes since 1976 to discern epidemiologic clues and determine successful diagnostic techniques and therapies; we found multiple cases due to cat scratch disease (CSD; due to Bartonella henselae) (twelve), tularemia (ten), sporotrichosis (three), Rickettsia conorii (three), R. typhi/felis (two), and herpes simplex virus (two) and single cases due to tuberculosis, paracoccidioidomycosis, Yersinia enterocolitica, Pasteurella multocida, Chlamydia trachomatis, Epstein–Barr virus, and Nocardia brasiliensis. Preauricular lymphadenopathy is a common clinical clue for POGS and is unusual in viral and bacterial conjunctivitis. For POGS, the major etiological consideration is B. henselae, which is usually diagnosed by the indirect immunofluorescence serologic technique. Although CSD POGS is usually self-limited, oral azithromycin may hasten resolution. However, other possible etiologies of POGS may also arise from cat or cat flea contact: sporotrichosis, tularemia, Pasteurella multocida, or FBT. If there is no cat contact, other epidemiologic and clinical findings should be sought, because several of these conditions, such as tularemia, paracoccidioidomycosis, and tuberculosis, may have grave systemic complications. Although there are usually no long-term ocular sequelae if POGS is properly diagnosed, it still may cause prolonged ocular discomfort and require multiple physician contacts.

Flea-Borne Typhus as a COVID-19 Mimic: A Report of Four Cases

“…For COVID-19 patients, D-dimer elevation was seen in 14–42% [ 33 ]. Elevated ferritin levels were found in two patients in this series but have not been commonly reported in FBT [ 29 , 34 , 35 ]. However, in COVID-19 serum ferritin levels >500 μ g/L were observed in all severe patients on admission [ 36 ].…”

Unilateral Conjunctivitis With Multifocal Granulomatous Lesions in a Child Aged 10 Years

“…She was treated with doxycycline, 100 mg, by mouth twice a day and rifampin, 300 mg, by mouth twice a day for 14 days, with resolution of the granulomatous lesions after 7 days. POGS is a unilateral granulomatous conjunctivitis with ipsilateral lymphadenopathy typically caused by Bartonella henselae; rare causes include Francisella tularensis and Mycobacterium tuberculosis , among others . This case was striking due to the prominent multifocal conjunctival granulomas and the rapid resolution after initiation of appropriate therapy.…”

“…POGS is a unilateral granulomatous conjunctivitis with ipsilateral lymphadenopathy typically caused by Bartonella henselae; rare causes include Francisella tularensis and Mycobacterium tuberculosis, among others. [1][2][3] This case was striking due to the prominent multifocal conjunctival granulomas and the rapid resolution after initiation of appropriate therapy.…”