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[Familial parinaud oculo-glandular syndrome in cat-scratch disease]
Insights
Cat-scratch disease, caused by Bartonella henselae, can lead to Parinaud oculoglandular syndrome. This report details a rare family case, highlighting the importance of considering cat exposure in atypical conjunctivitis.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Cat-scratch disease (CSD) is a common zoonotic infection primarily affecting children, caused by Bartonella henselae.
- Parinaud oculoglandular syndrome (POS) is the most frequent ocular manifestation of CSD, characterized by conjunctivitis and regional lymphadenopathy.
- Diagnosis relies on clinical presentation, history of cat exposure, and confirmation via serologic tests or PCR assays.
Observation:
- This case report describes two sisters presenting with POS, a rare familial occurrence.
- Both sisters had a history of close contact with cats, including a kitten.
- They presented with refractory conjunctivitis and signs suggestive of periorbital cellulitis.
Findings:
- POS was confirmed in both sisters through positive serologic tests for Bartonella henselae.
- Treatment with oral tetracycline resulted in apparently good responses for their conjunctivitis and associated symptoms.
- The report emphasizes the diagnostic value of inquiring about cat contact in atypical conjunctivitis cases.
Implications:
- Clinicians should consider cat exposure in the differential diagnosis of atypical conjunctivitis, especially in pediatric patients with regional lymphadenopathy.
- Prompt systemic antibiotic treatment, such as tetracycline, is recommended for suspected significant ocular involvement, immunosuppressed individuals, or systemic CSD manifestations.
- This case underscores the importance of recognizing POS and its association with Bartonella henselae infection in familial clusters.
Abstract:
Cat-scratch disease is manifested by subacute, regional lymphadenitis and occurs mainly in children. The causative agent is a pleomorphic, gram-negative bacillus, Bartonella henselae carried by asymptomatic cats. Parinaud oculoglandular syndrome is the most common ocular manifestation of this disease. It is characterized by unilateral conjunctivitis with polypoid granuloma, usually of the palpebral conjunctiva, and preauricular lymphadenopathy. The diagnosis is supported by a history of exposure to cats and is confirmed by positive serologic tests or positive PCR assay. The occurrence of more than 1 case of Parinaud syndrome in a family is rare. We describe 2 sisters with Parinaud oculoglandular syndrome, proven by serologic tests. They reported that they used to cuddle with their cats, among them a kitten. Because of the refractory conjunctivitis and signs of imminent periorbital cellulitis, they were treated with oral tetracycline with apparently good responses. We recommend asking about contacts with cats in any atypical conjunctivitis accompanied by regional lymphadenopathy, especially in young patients. Systemic antibiotics should be given when there is any suspicion of significant ocular involvement, if the patient is immunosuppressed, or if there are systemic manifestations of cat-scratch disease.