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Atypical Haemorrhagic Presentation of Neuro-Retinitis and Serous Retinal Detachment Secondary to Cat-Scratch Disease
Henry C Skrehot1, Amer F Alsoudi2, Ryan P Nolan2
1School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Insights
Cat-scratch disease (CSD), caused by Bartonella henselae, can lead to neuroretinitis, an optic nerve condition. This case highlights successful treatment of neuroretinitis with antibiotics and steroids, restoring vision.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Cat-scratch disease (CSD) is typically caused by Bartonella henselae.
- Neuroretinitis, optic disc swelling with a macular star, is a rare CSD manifestation (1-2% of cases).
Purpose of the Study:
- To report a case of neuroretinitis secondary to CSD in a pediatric patient.
- To describe the clinical presentation, diagnostic findings, and treatment outcomes.
Main Methods:
- Case report of a 14-year-old female with acute vision loss.
- Ophthalmic examination including funduscopy and optical coherence tomography (OCT).
- Treatment with doxycycline, rifampin, and a prednisone taper.
Main Results:
- The patient presented with unilateral vision loss, optic disc edema, macular star, and subretinal fluid.
- OCT confirmed serous retinal detachment and optic disc edema.
- Treatment resulted in improved vision, reduced optic disc edema, and resolution of subretinal fluid.
Conclusions:
- Neuroretinitis is an uncommon but treatable manifestation of CSD.
- Combination antibiotic therapy and corticosteroids can effectively manage CSD-induced neuroretinitis.
- Prompt diagnosis and treatment are crucial for visual recovery.
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.
