Atypical Haemorrhagic Presentation of Neuro-Retinitis and Serous Retinal Detachment Secondary to Cat-Scratch Disease

Abstract

Cat-scratch disease (CSD) is a self-limited disease caused by Bartonella henselae, a fastidious gram-negative intracellular bacillus bacterium. Neuroretinitis, a form of optic neuropathy characterised clinically by optic disc swelling and a macular star, is an uncommon manifestation of CSD occurring in approximately 1-2% of cases. We report a case of a 14-year-old female who presented to the emergency department with a chief complaint of acute painless vision loss described as a large black spot in the centre of her right eye vision 2 weeks after being scratched by cats. Fundus examination revealed Frisen grade 5 disc oedema with an atypically diffuse disc and peripapillary haemorrhages with associated subretinal fluid and a macular star in the right eye. Optical coherence tomography (OCT) of the macula and retinal nerve fibre layer showed subretinal fluid involving the fovea, a serous retinal detachment of the nasal macula, and significant optic disc oedema in the right eye. The patient was admitted and treated with doxycycline, rifampin, and prednisone taper. After completing the treatment course, the patient's vision improved, fundus examination showed significantly improved disc oedema and haemorrhages, and OCT demonstrated resolution of the subretinal fluid in the right eye.

Keywords: Bartonella Henselae; Neuroretinitis; cat-scratch disease; optic disc oedema; peripapillary haemorrhage; serous retinal detachment.

Figure 1.

a. Photograph of the cat scratch wounds on the patient’s hand. b. OCT of the right eye depicting subretinal fluid involving the fovea and a serous retinal detachment of the nasal macula. c. OCT of the retinal nerve fibre layer depicting significant optic disc oedema in the right eye. d. Humphrey visual field 24-2 of the right eye demonstrating an enlarged blind spot.

Figure 2.

a. Fundus photograph of right eye showing Frisen grade 5 disc oedema with atypically diffuse disc and peripapillary haemorrhages with associated subretinal fluid and a macular star (visual acuity: 20/200). b. Fundus photograph of right eye post treatment showing improved disc oedema and peripapillary haemorrhages with resolution of the subretinal fluid (visual acuity: 20/30 + 2).

Figure 3.

a. OCT of the right eye depicting resolution of subretinal fluid at 6 weeks of follow-up after antibiotic and steroid treatment. b. OCT of the retinal nerve fibre layer depicting resolution of optic disc oedema at 6 weeks of follow-up after antibiotic and steroid treatment.