Retinal and choroidal manifestations of cat-scratch disease

Ormerod, L. David; Skolnick, Keith A.; Menosky, Matthew M.; Pavan, Peter R.; Pon, D M

doi:10.1016/s0161-6420(98)96003-1

Cited by 115 publications

(60 citation statements)

References 28 publications

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“…Optic nerve head leakage can be easily demonstrated on FA in cases of CSD neuroretinitis, however, macular changes are poorly visible, 10,11 as was also shown in our study. We showed that the OCT is able to accurately demonstrate the macular findings described above in a qualitative and a quantitative manner.…”

Section: Discussionsupporting

confidence: 73%

“…[3][4][5] Disseminated CSD may involve the eye and cause vision-threatening manifestations, including neuroretinitis, optic neuritis, retinitis, choroiditis, anterior uveitis, vitritis, branch retinal arteriolar and venular occlusions, vasculitis, and peripapillary angiomatosis. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In 1970, Sweeney and Drance 22 were first to find a connection between CSD and the appearance of neuroretinitis. Since then, numerous reports had been published on cases of neuroretinitis in CSD and it is the most common posterior segment complication of CSD.…”

Section: Introductionmentioning

confidence: 99%

“…23 Neuroretinitis is characterized by optic nerve swelling, which usually resolves within 2-8 weeks, accompanied by stellate macular exudates that become prominent over the first 2 or 3 weeks. Additional manifestations that may accompany neuroretinitis include intra-retinal hemorrhages, 10 focal or multifocal retinitis or choroiditis, 7,11 retinal artery and vein occlusions, 11,12,20 and anterior or intermediate uveitis. 7,9 The diagnosis of CSD neuroretinitis is made clinically and confirmed by positive serology and fluorescein angiography (FA).…”

Section: Introductionmentioning

confidence: 99%

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Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis

Habot‐Wilner

Zur

Goldstein

et al. 2011

Eye

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Purpose To describe the macular findings on optical coherence tomography (OCT) in patients with cat-scratch disease (CSD) neuroretinitis. Methods Medical records of all patients diagnosed with CSD neuroretinitis at the Tel Aviv Medical Center between April 2006 and May 2010 were retrospectively reviewed. All patients underwent Stratus OCT macular examination. Results Eight eyes of seven patients with confirmed CSD neuroretinitis, (mean age 33±9.9 years, range 6-48 years) were included in the study. All patients presented clinically with optic nerve swelling and macular edema or macular exudates. OCT demonstrated flattening of the foveal contour, thickening of the neurosensory retina, and accumulation of subretinal fluid (SRF) in all studied eyes. Retinal exudates appeared as multiple hyper-reflective foci in the outer plexiform layer. The average central macular thickness was 460 lm (range 170-906 lm) and the average maximal retinal thickness was 613 lm (range 387-1103 lm), at presentation. The macula appeared normal on repeated exams during follow-up. Conclusion Similar OCT findings were demonstrated in patients with CSD neuroretinitis. SRF was found in all eyes, although was not visible on clinical examination or fluorescein angiography. OCT may be used as an adjunct imaging tool in the diagnosis and follow-up of patients with CSD neuroretinitis.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis

Habot‐Wilner

Zur

Goldstein

et al. 2011

Eye

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“…14 Omerod noted up to 27 central retinal or choroidal white dots (bilateral in an estimated 75% of cases), usually clearing completely but sometimes leaving pigmented scars: retinal disease was associated with vitritis in 50% and nongranulomatous anterior uveitis in <15% of their cases. 15 Retinal biopsy can confirm that the lesions contain Bartonella colonies. 16 In a relatively large study (n = 35), Solley et al 8 reviewed photographs to determine the depth of infiltrates: 30% occurred in the superficial retina; 49%, in deep retina; 14% were full-thickness; and 7% were in the choroid.…”

Section: Diagnosis and Discussionmentioning

confidence: 99%

A 31-year-old man with bilateral blurry vision and floaters

2015

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SummaryWe report a case of bilateral multifocal retinochoroiditis and bilateral optic disc edema in a patient with catscratch disease from Bartonella henselae. The patient initially had negative serologic testing. Repeat testing showed a markedly increased IgG and IgM convalescent titer and the development of a branch retinal artery and vein occlusion. In patients for whom there is a high clinical suspicion of cat-scratch disease, a convalescent titer should be obtained 2-3 weeks following a negative initial result. HistoryA 31-year-old male presented to Stony Brook University with bilateral blurry vision and floaters. The vision loss was of sudden onset, but the patient denied ocular pain. He had a history of flulike illness with malaise, fever, myalgia, and upper respiratory symptoms 1 week earlier. ExaminationOn examination, best-corrected visual acuity was 20/20 in each eye. Slit-lamp examination was remarkable for 1+ anterior chamber cell in both eyes, 3+ anterior vitreous cell in the right eye and +1 in the left eye. Dilated fundus examination disclosed bilateral disc edema, more prominent on the right more than the left, and multifocal deep retinal and choroidal yellowish infiltrates 100-300 μm in diameter (Figure 1). Ancillary TestingLaboratory workup for bilateral uveitis and multifocal retinochoroiditis included negative serology for Lyme IgM and IgG; Bartonella IgM and IgG; Epstein-Barr virus; hepatitis A, B, and C; toxoplasma; syphilis; HIV; anti-nuclear antibody; anti-neutrophil cytoplasmic antibody; anti-double stranded DNA; and complement levels. He had a slightly elevated angiotensin converting enzyme (ACE) titer (74 U/L; normal range, 12-68 U/L). Because of his borderline ACE and to rule out sarcoidosis, he underwent chest computed tomography, which did not show any evidence of hilar adenopathy or interstitial lung disease. TreatmentThe patient was started on 60 mg oral prednisone daily, which was tapered over 1 month. At 1 month after the initial presentation, his visual acuity was 20/20 in each eye. He had mild vitreous cells and mild disc edema bilaterally. In addition, he had developed stellate macular exudates (macular star) in the right eye, retinal vasculitis, and a branch retinal artery and vein occlusion in the left eye (Figure 2). A repeat Bartonella titer was positive at IgG > 1/2560 (negative, <1/320) and IgM 1/200 (negative, <1/100). On further questioning, the patient mentioned he had recently been exposed to a cat. He was started on doxycycline and rifampin. Two months later, his visual acuity remained 20/20, and the disc edema had resolved. The vitritis and macular exudates had cleared completely, but he had developed nasal chorioretinal scars (Figure 3). On his most recent examination, 1 year after initial presentation, his visual acuity

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“…These alterations are denominated neuroretinitis and CSD is its most common cause. Very often patients also complain of visual loss, generally reversible with antibiotic treatment [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Cat scratch disease complicated with aseptic meningitis and neuroretinitis

Pinto¹,

Curi²,

Pinto³

et al. 2008

Braz J Infect Dis

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Cat scratch disease (CSD) is a self limited condition characterized by fever, lymph node enlargement and less often eye involvement. Central nervous system involvement by Bartonella henselae infection is possibly an important cause of morbidity; its role as an agent of aseptic meningitis is unknown. We report a case of a 40 years-old man with CSD accompanied by aseptic meningitis and neuroretinitis. Serum indirect immmunofluorescence (IFI) assays for B. henselae were positive and the cerebrospinal fluid (CSF) analysis showed mononuclear pleocytosis and increased level of protein. Serological tests for other etiologies were negative. The patient responded well to antibiotic therapy with oral doxycicline plus rifampin and in the 12 th day of hospitalization evolved to total regression of the headache and partial regression of the visual loss. Clinicians should consider CSD as a differential diagnosis when assessing previously healthy patients with aseptic meningitis associated with regional lymphadenopathy and epidemiological history of feline contact.

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Retinal and choroidal manifestations of cat-scratch disease

Cited by 115 publications

References 28 publications

Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis

Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis

A 31-year-old man with bilateral blurry vision and floaters

Cat scratch disease complicated with aseptic meningitis and neuroretinitis

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