Severe Optic Neuroretinitis and Vitreous Hemorrhage in Pediatric Cat-Scratch Disease: A Case With Irreversible Visual...

BACKGROUND Cases of cat-scratch disease involving both systemic and ocular manifestations typically have a favorable prognosis and usually resolve spontaneously within 1-2 months. However, rare cases with severe ocular involvement may result in irreversible visual impairment. We report a pediatric case in which severe optic neuroretinitis and vitreous hemorrhage developed unilaterally, leading to poor visual recovery. CASE REPORT A 6-year-old girl presented with decreased vision in her right eye 2 months after a febrile illness. Best-corrected visual acuity was counting fingers at 10 cm in the right eye. Fundus examination revealed optic disc edema, serous retinal detachment, vitreous hemorrhage, and multiple exudates extending to the periphery. Magnetic resonance imaging, blood tests, and fluorescein angiography were performed to differentiate optic neuroretinitis, but no disease-specific findings were identified. Due to a history of cat scratches, cat-scratch disease was suspected, and treatment with oral azithromycin (300 mg/day) and prednisolone (0.5 mg/kg/day) was initiated. The vitreous hemorrhage, serous detachment, and exudates gradually improved. Serological testing subsequently confirmed Bartonella henselae infection (IgM 1: 40, IgG ≥1: 1024). After 19 months, her best-corrected visual acuity improved to 20/100, but a central relative scotoma remained. CONCLUSIONS This case highlights that a delayed recognition of visual loss in pediatric patients with cat-scratch disease may allow severe inflammation to persist, ultimately leading to irreversible visual impairment, despite administering combined antibiotic and corticosteroid therapy.