Isolated conjunctival granuloma as a first manifestation of Parinaud's oculoglandular syndrome: A case report

Abstract

Purpose: Parinaud's oculo-glandular syndrome (POGS) is the most frequent manifestation of ocular bartonellosis, and usually presents with local lymphadenopathies and systemic symptoms. We present a case of isolated conjunctival granuloma as the sole manifestation of ocular bartonellosis.

Observations: A 67-year-old female presented to the authors' eye clinic with complaints of a 2-week history of unilateral red eye and chemosis. Slit lamp examination revealed an isolated bulbar conjunctival granuloma. The remainder of the eye examination was unremarkable. Topical treatment with gatifloxacin and prednisolone acetate was started. Etiological work-up was performed. General laboratory tests revealed only a mild leukocytosis, and interferon gamma-release assay and chest computed tomography were normal. Serological testing for Bartonella henselae was positive at titers of 1:1024. Three weeks after initial symptoms, lymphadenopathies, malaise, and fever appeared. Systemic azithromycin was added, which resulted in complete regression of the disease.

Conclusion and importance: Conjunctival granulomas present a wide range of differential diagnoses to the practitioner. Ocular bartonellosis is a relevant cause of conjunctival granuloma. POGS should be suspected in cases of conjunctival granulomata non-responsive to local therapy. It is important to consider that other agents to treat POGS have been described and are available, and that appropriate serological tests should be performed.

Keywords: Cat scratch disease; Conjunctival granuloma; Ocular bartonellosis; Parinaud.

Fig. 1

Slit-lamp image demonstrating an elevated granulomatous lesion of the bulbar conjunctiva.

Fig. 2

Slit-lamp image of conjunctival granuloma with central epithelial necrosis.