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Case Reports
. 2021 Aug 15:69:102722.
doi: 10.1016/j.amsu.2021.102722. eCollection 2021 Sep.

Cat scratch disease neuroretinitis: A case report

Ahmed Mahjoub  1 , Foued Bellazreg  1   2 , Nadia Ben Abdesslem  1 , Ilhem Sellem  1 , Anis Mahjoub  1 , Syrine Ben Mrad  1 , Mohamed Ghorbel  1 , Amel Letaief  1   2 , Mahjoub Hachmi  1 , Krifa Fethi  1
Affiliations
Case Reports

Cat scratch disease neuroretinitis: A case report

Ahmed Mahjoub et al. Ann Med Surg (Lond). .

Abstract

Introduction: Cat scratch disease (CSD) is a ubiquitous infectious disease caused by a Gram-negative intracellular bacillus, Bartonella henselae. Neuroretinitis is a classical but rare manifestation of CSD.

Case presentation: A 20-year-old woman presented with a 5-day-history of reduced vision in the left eye (LE). Two weeks before eye symptoms, she complained from fever, fatigue and arthromyalgia which resolved spontaneously. In the LE, visual acuity (VA) was 7/10, fundus photography showed optic disc edema with macular exudates arranged in incomplete macular star. Serologic test for Bartonella henselae using indirect immunofluorescent assay (IFA) was highly positive (1:2560 UI/L) for immunoglobulin G (Ig G). The diagnosis of CSD associated neuroretinitis has been made and the patient was treated with doxycycline, rifampicin and oral prednisolone. Twelve months after the end of therapy, VA was 10/10, fundus photography and Macular OCT were normal.

Discussion: In CSD, neuroretinitis occurs 2-3 weeks after systemic symptoms. The clinical features of CSD are not specific hence the need for bacteriological diagnosis which is based mainly on serologic testing by the detection of Ig G and Ig M by IFA or ELISA. The treatment of CSD-associated neuroretinitis is not standardized. Antibiotics active against intracellular bacteria, with or without systemic corticosteroids, should be prescribed especially in severe cases. The outcome of Bartonella henslae neuroretinitis is usually favourable.

Conclusion: Despite rarely reported in Tunisia, CSD should be considered in patients with presence of typical neuroretinitis with macular star and of a history of contact with cats.

Keywords: Bartonella henslae; Cat scratch disease; Doxycycline; Eye infections; Neuroretinitis.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Left eye cat scratch disease neuroretinitis (at admission) A. Fundus photograph of the left eye shows optic disc edema (a) with macular exudates arranged in incomplete macular star (b). B. Late-phase FA shows optic disc hyperfluorescence (c). C. Macular OCT shows hyperreflective signals at level of the outer plexiform layer representing retinal exudates (d).
Fig. 2
Fig. 2
Left eye cat scratch disease neuroretinitis (at the end of antibiotic and corticosteroid therapy). A. Fundus photograph shows a decrease in optic disc edema (a) and a decrease in macular exudates (b). B. Late-phase fluorescein angiogram shows a decrease in optic disc hyperfluorescence (c).
Fig. 3
Fig. 3
Left eye cat scratch disease neuroretinitis (12 months after the end of therapy). A. Normal fundus. B. Normal macular OCT.
See this image and copyright information in PMC

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