Diverse Clinical Signs of Ocular Involvement in Cat Scratch Disease

Objectives: To describe ocular manifestations, diagnosis, and treatment of cat scratch disease. Materials and Methods: Clinical records of patients with ocular cat scratch disease were reviewed. Results: Thirteen eyes of 10 patients (7 female, 3 male) with a mean age of 26.9±18.5 years were included. Nine patients had a history of cat contact and had systemic symptoms associated with cat scratch disease 2-90 days prior to the ocular symptoms. Ocular signs were: neuroretinitis in 4 eyes (associated with serous retinal detachment in the inferior quadrant in 1 eye), optic neuropathy in 2 eyes (1 papillitis and optic disc infiltration, 1 optic neuritis), retinal infiltrates in 6 eyes, retinochoroiditis in 1 eye, branch retinal arteriolar occlusion in 3 eyes, and endophthalmitis in 1 eye. Visual acuities at presentation were 1.0 in 7 eyes, 0.3 in 1 eye, ≤0.1 in 4 eyes, and light perception in 1 eye. Bartonella henselae immunoglobulin (Ig) M and/or IgG were positive in all patients. Systemic antibiotic therapy was administered in all patients. Systemic corticosteroid treatment (15-40 mg/day) was added to the therapy in 4 patients, following 5 days of intravenous pulse methylprednisolone in 2 patients. Treatment was ongoing for 1 patient and the mean treatment duration of the other 9 patients was 47±14.5 days. Visual acuities at final visit were 1.0 in 9 eyes, 0.8 in 1 eye, 0.4 in 1 eye, and no light perception in 1 eye. Conclusion: Cat scratch disease may present with different ocular signs and should be considered in the differential diagnosis in patients with such presentations.

[1]  M. Kramer,et al.  Retinal artery occlusion due to Bartonella henselae infection: a case series , 2016, Acta ophthalmologica.

[2]  S. Kabanarou,et al.  Retinal Arterial Occlusive Disease in a Young Patient with Cat Scratch Disease , 2013, Case Reports in Ophthalmology.

[3]  S. Rumelt,et al.  [Leber's idiopathic stellate neuroretinitis]. , 2013, Harefuah.

[4]  K. Golnik,et al.  Cat scratch neuroretinitis: the role of acute and convalescent titers for diagnosis. , 2012, Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society.

[5]  A. Pinna,et al.  Unusual retinal manifestations of cat scratch disease , 2011, International Ophthalmology.

[6]  Douglas A Jabs,et al.  Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. , 2005, American journal of ophthalmology.

[7]  Andrew D. Dick,et al.  The standardization of uveitis nomenclature (SUN) working group; standardization of uveitis nomenclature for reporting clinical data: Results of the first international workshop , 2005 .

[8]  A. Lauer,et al.  Bartonella henselae infection associated with neuroretinitis, central retinal artery and vein occlusion, neovascular glaucoma, and severe vision loss. , 2004, American journal of ophthalmology.

[9]  D. Goldstein,et al.  Acute endogenous endophthalmitis due to Bartonella henselae. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  E. Eggenberger Cat scratch disease: posterior segment manifestations. , 2000, Ophthalmology.

[11]  L. Morse,et al.  Bartonella henselae infection associated with peripapillary angioma, branch retinal artery occlusion, and severe vision loss. , 1999, American journal of ophthalmology.

[12]  J. P. Dailey,et al.  Ocular manifestations of cat-scratch disease. , 1999, Current opinion in ophthalmology.

[13]  E. Goldstein,et al.  Use of retinal biopsy to diagnose Bartonella (formerly Rochalimaea) henselae retinitis in an HIV-infected patient. , 1998, Archives of ophthalmology.

[14]  P. Pavan,et al.  Retinal and choroidal manifestations of cat-scratch disease. , 1998 .

[15]  I. Schwab,et al.  Bartonella henselae neuroretinitis in cat scratch disease. Diagnosis, management, and sequelae. , 1998, Ophthalmology.

[16]  D. Spach,et al.  Bartonella-associated infections. , 1998, Infectious disease clinics of North America.

[17]  J. Tappero,et al.  Molecular epidemiology of bartonella infections in patients with bacillary angiomatosis-peliosis. , 1997, The New England journal of medicine.

[18]  R. Jerris,et al.  Will the real agent of cat-scratch disease please stand up? , 1996, Annual review of microbiology.

[19]  N. Pedersen,et al.  Experimental transmission of Bartonella henselae by the cat flea , 1996, Journal of clinical microbiology.

[20]  W. Schwartzman Bartonella (Rochalimaea) infections: beyond cat scratch. , 1996, Annual review of medicine.

[21]  T. Hadfield,et al.  Prolonged Bartonella bacteremia in cats associated with cat-scratch disease patients , 1995, Journal of clinical microbiology.

[22]  S. Cohen,et al.  Branch retinal arterial occlusions in multifocal retinitis with optic nerve edema. , 1995, Archives of ophthalmology.

[23]  J. Klein Cat scratch disease. , 1994, Pediatrics in review.

[24]  J. Tappero,et al.  Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir. , 1994, JAMA.

[25]  J. Hadler,et al.  Cat scratch disease in Connecticut. Epidemiology, risk factors, and evaluation of a new diagnostic test. , 1993, The New England journal of medicine.

[26]  A. Weiss,et al.  Neuroretinitis in childhood. , 1989, Journal of pediatric ophthalmology and strabismus.