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P. Khator, J. Thompson; An Atypical Case of Cat–Scratch Disease Neuroretinitis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):613.
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To describe an atypical case of cat–scratch disease neuroretinitis.
Case report of a 26–year old female with cat–scratch disease neuroretinitis followed prospectively.
A 26–year old black female presented complaining of "blurry vision" in the left eye since splashing alcohol in her eye 2 weeks ago. Patient’s best–corrected visual acuity was 20/20 in the right eye and counting fingers at 7’ in the left eye. The patient had a relative afferent pupillary defect in the left eye and a left inferior defect on VFH. Dilated fundus exam revealed an edematous and elevated optic nerve. A macular star consisting of hard exudates was also noted (Figure 1). A thorough review of systems was negative. Patient did admit to being scratched by a kitten 4 weeks prior to presentation. Physical examination by an infectious disease specialist was normal without any lymphadenopathy. HIV antibodies were negative. Bartonella Henselae IgG and IgM antibodies were positive. The patient was treated with a 14–day course of Bactrim. At 6–week follow–up, the visual acuity was 20/500 in the left eye. Disc edema had completely resolved but significant macular exudates remained (Figure 2). At 14 weeks, the visual acuity was 20/320 in the left eye. Fundus exam in the left eye showed sharp disc margins with improved appearance of the macular exudates and retinal pigment epithelium hyperpigmentation in the macular region. An HRT macular scan showed macular edema in the region of exudates. At 9–month follow–up, visual acuity had improved to 20/200 in the left eye and fundus exam revealed complete resolution of macular exudates. Increased macular pigmentation was consistent with previous serous detachment (Figure 3). Optic disc was without pallor. Fluorescein angiogram showed no macular edema or current serous detachment (Figure 4).
Cat–scratch disease caused by Bartonella Henselae remains the most common cause of neuroretinitis. This patient was atypical in that she did not have systemic manifestations usually associated with this condition. Of interest in this case report is the fulminant presentation after an isolated exposure and persisting decreased acuity despite a normal fundus and angiographic appearance at 9 months.
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