Abstract
Cat scratch disease (CSD) is caused by a gram-negative bacterium, Bartonella henselae. This uncommon disease is believed to be transmitted by a cat scratch or bite, when the bacterium is present on the cat’s claw or resides in the oral cavity. There are approximately 22,000 cases of CSD diagnosed in the United States annually. Neuroretinitis (NR), which occurs in 1%-2% of CSD cases, is characterized by acute vision loss, optic disc edema, and a macular star. Diagnosis can be aided by fundus examination, optical coherence tomography (OCT), fluorescein angiography (IVFA), and serological testing for B. henselae infection. Cat scratch disease is usually self-limiting; however, oral antibiotics may shorten the duration of the disease.
Highlights
Neuroretinitis (NR), secondary to cat scratch disease (CSD), is typically a self-limiting condition caused by an infectious and inflammatory reaction of the optic nerve, followed by the formation of a macular star [1,2]
The serologic tests confirmed the diagnosis of NR secondary to cat scratch disease (CSD), and sulfamethoxazole/trimethoprim (Bactrim 400 mg/80 mg tablets) was prescribed, one tablet every 12 hours for three weeks
Patients with cat scratch neuroretinitis (CSNR) can sometimes report ocular discomfort and it is important that other neurological conditions, where pain is more common, such as neuritis and neuromyelitis optica (NMO) be excluded [23,24]
Summary
Neuroretinitis (NR), secondary to cat scratch disease (CSD), is typically a self-limiting condition caused by an infectious and inflammatory reaction of the optic nerve, followed by the formation of a macular star [1,2]. Confrontation visual fields demonstrated superior-temporal and inferior defects in the left eye, which were supported by the findings on Amsler grid testing. The cat scratched her arms and she subsequently developed a skin rash and a tender anterior cervical lymphadenopathy Three weeks later, she noted blurry vision in her left eye, which prompted the emergency room visit. The serologic tests confirmed the diagnosis of NR secondary to cat scratch disease (CSD), and sulfamethoxazole/trimethoprim (Bactrim 400 mg/80 mg tablets) was prescribed, one tablet every 12 hours for three weeks. The patient returned six weeks later and stated that the vision in the left eye was much better, but that mild visual distortion remained. The patient showed improvement on visual field testing, using a size III target in the left eye. The patient demonstrated considerable improvement; she was advised to return in two months for a scheduled follow-up, or as needed if any new concerns should manifest
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