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

Abstract

We report a case of bilateral multifocal retinochoroiditis and bilateral optic disc edema in a patient with cat-scratch 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.

Figure 1.

Fundus photographs of a 31-year-old man initially presenting with bilateral disc edema, in evidence more on the right (A) than the left (B), and multifocal deep retinal and choroidal yellowish infiltrates 100–300 μm in diameter. Representative fluorescein angiography of the right eye (at 40 seconds) shows prominent optic disc capillary dilation with hyperfluorescence and blockage at the site of the retinitis in the inferotemporal macula (C); the left eye (at 55 seconds) shows prominent optic disc capillary dilation as well as hypofluorescence at the site of the retinitis inferiorly (D).

Figure 2.

Fundus photographs 1 month after presentation shows stellate macular exudates (macular star) in the right eye (A) as well as a branch retinal artery and vein occlusion in the left eye (B). Representative fluorescein angiography of the right eye (at 1 minute 38 seconds) shows that the inferotemporal site of blockage has cleared (C); in the left eye (at 39 seconds) there is no perfusion distal to the branch retinal artery and vein occlusion with surrounding hypofluorescence from retinal edema present (D).

Figure 3.

Fundus photograph showing the areas of retinitis becoming chorioretinal scars.