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Case Reports
. 2022 Oct 13:2022:2841683.
doi: 10.1155/2022/2841683. eCollection 2022.

A Case of Cat Scratch Disease with Neuroretinitis in a 16-Month-Old Boy

Daisuke Nakata  1   2 , Sayaka Kakehi  1 , Hiroshi Okada  1 , Atsuhiro Tanikawa  2 , Yoshiaki Shimada  2 , Masayuki Horiguchi  2 , Yasuki Ito  2
Affiliations
Case Reports

A Case of Cat Scratch Disease with Neuroretinitis in a 16-Month-Old Boy

Daisuke Nakata et al. Case Rep Ophthalmol Med. .

Abstract

Purpose: We report a case of neuroretinitis associated with cat scratch disease (CSD) in young children.

Method: Case report.

Results: A 16-month-old boy was admitted for a detailed examination and treatment of a fever of unknown origin. Blood tests revealed no significant findings other than a white blood cell count of 16,100/mm3 and C-reactive protein level of 9.89 mg/dL. Computed tomography revealed no relevant findings to determine the causative disease. Antibiotic therapy with cefotaxime was initiated; however, the fever did not resolve. The patient was referred to our department for further examination to detect the cause of the fever. Fundoscopy revealed neuroretinitis in the right eye. His mother reported a history of breeding cats. Cat scratch disease (CSD) was suspected based on the clinical course and fundus findings. Cefotaxime was discontinued, and azithromycin, rifampicin, and prednisolone were administered, following which the fever disappeared and fundus findings improved. Immunoglobulin G (IgG) and IgM antibodies against Bartonella henselae was positive, leading to a definitive diagnosis of CSD.

Conclusion: Infants cannot complain of decreased visual acuity; therefore, these findings may be overlooked unless a fundus examination is performed. As in this case, the early detection of neuroretinitis by an ophthalmologist may help in the diagnosis of CSD. It is extremely difficult to capture a photograph of the fundus of an infant, and recording with a smartphone is relatively simple and useful for monitoring continuous changes. Summary. We describe a case of neuroretinitis associated with cat scratch disease (CSD) that was diagnosed on the basis of fundus findings. The findings suggest the importance of an aggressive ophthalmologic examination when CSD is suspected in young children who are unable to describe their symptoms.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Right eye at the first visit of the examination: papilledema and macular star exudates imaged using a smartphone.
Figure 2
Figure 2
Right eye at the 2-month follow-up after discharge, imaged using a smartphone.
See this image and copyright information in PMC

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