Multiple ocular manifestations in a case of cat scratch disease without systemic signs

Abstract

A 43-year-old woman presented with impaired vision and redness in her left eye of 2 weeks duration. She had a pet cat that scratched her forehead 3 weeks before she presented to us. She had no systemic signs such as lymphadenopathy, fever, or fatigue. The respective right and left corrected visual acuities were 20/16 and 20/2000. The anterior chamber of the left eye exhibited inflammation; a fundus examination of that eye revealed optic disc swelling and a serous macular detachment with hard stellate exudates. Based on the recent cat scratch and the ocular findings, cat scratch disease (CSD) was suspected. The results of serologic testing showed elevated titres of IgM and IgG antibodies to Bartonella henselae. Administration of doxycycline and a steroid was initiated. This report describes the occurrence of multiple ocular manifestations of CSD in both the posterior and the anterior segment.

Keywords: anterior uveitis; cat scratch disease; serous macular detachment.

Figure 1. The chemosis with serous discharge

Figure 2. Keratic precipitates and cells in the anterior chamber

Figure 3. Optic disc swelling, a focal retinitis lesion at the temporal margin of the optic disc, macular exudates in a star pattern, and a flame-like retinal haemorrhage

Figure 4. A serous macular detachment

Figure 5. Leakage from the optic disc of the left eye (fluorescein angiography)

Figure 6. After the treatment, optic disc edema, focal retinal infiltrates, retinal haemorrhage, serous retinal detachment, and macular exudates decreased.