Utility of MR imaging in cat-scratch neuroretinitis

Abstract

About 80% of cat-scratch disease (CSD) infections occur in children, and CSD neuroretinitis (optic neuropathy with retinal exudates in a "macular star" pattern) mostly occurs in children and young adults. A recent study suggested that CSD optic neuropathy has specific features on MR imaging. However, MR imaging findings in CSD neuroretinitis are not well described in the pediatric literature. We present a patient with CSD neuroretinitis in whom these specific MR imaging features preceded the macular star, a funduscopic finding strongly suggestive of neuroretinitis. This case demonstrates how knowledge of these features is important in the appropriate diagnostic work-up of optic neuropathy. MR imaging also incidentally revealed neuritis of another cranial nerve in the auditory canal-a rare manifestation of CSD.

Neuroretinitis: Review of the Literature and New Observations

“…The consistent absence of these changes and the failure to develop clinical MS on long-term follow-up (87) have put this issue to rest. Two additional cases with similar findings have been reported (46,102). Schmalfuss et al (101) evaluated the MRI findings in 82 patients with various optic neuropathies, including 9 with CSD.…”

An Adolescent With a Swollen Nerve

“…3,4 Because of the high likelihood that patients who present with isolated disc edema will undergo neuroimaging, there has been interest in identifying characteristic magnetic resonance imaging findings in cat scratch disease. 5 However, the clinical findings, along with positive serologic test results, remain the mainstay of diagnosis. Therefore, a detailed history and appropriate serologic testing should be obtained at the time of imaging.…”

Neuroretinitis Caused byBartonella henselae(Cat-Scratch Disease) in a 13-Year-Old Girl

“…The finding of disc swelling associated to macular star exudates, as it happened in this patient, is considered as a predictable sign of an ocular manifestation of cat-scratch disease [9, 14, 15]. However, other etiologies should be discarded as a cause of optic neuropathy, such as arterial hypertension, diabetes mellitus, pseudotumor cerebri, syphilis, tuberculosis, toxoplasmosis, Lyme disease, HIV, leptospirosis, and even multiple sclerosis and/or acute disseminated encephalomyelitis (although the characteristic star exudates are not observed in demyelinating diseases [5, 9, 16]). …”

“…The possibility of ophthalmic irreversible structural lesions [5, 17, 18, 21, 22] suggests prescription of combined antibiotic therapy: rifampicin and doxycycline in patients older than eight and rifampicin with azithromycin or co-trimoxazole for patients below that age of four to six weeks [19]. In this patient, antibiotic prescription was based upon clinical and epidemiological suspicion, and steroids were prescribed despite questionable usefulness [9, 15, 16, 22] after the visual evoked potential test findings. Quick and complete recovery of ophthalmic symptoms experienced by this patient, in contrast to other cases referred to by the literature [11, 12, 18], could be in relation to the prompt beginning of treatment.…”