Monocular Neuroretinitis Secondary to Bartonella Henselae Infection

Abstract

Bartonella henselae is a Gram (-) rod that causes Cat-scratch disease. The most common clinical manifestations of the disease are fever and lymphadenopathy, sometimes accompanied by skin changes at the site of penetration. Eye involvement has variable clinical presentations. The most characteristic sign is Parinaud’s oculoglandular syndrome, although in atypical cases unilateral neuroretinitis could be observed, as it is in the clinical case we present. The patient, P.K.K., 30 years-old man, admitted to the clinic with complaints of impaired vision in his right eye, after undergoing lymphadenopathy in the right half of the neck, 2 weeks earlier. The conducted medical tests (visual acuity test, optical coherence tomography, computer perimetry, Eidon confocal scan) showed visual acuity 0,15, fundus examination: irregular borders and hyperemia of the optic nerve, optic nerve prominence 1 D, tortuous venous blood vessels peripapillary, diffuse flame hemorrhages around the papilla, and in the macula- ”macular star”. Laboratory tests came back positive for IgM for Bartonella henselae, confirming the diagnosis of unilateral neuroretinitis caused by Cat-scratch disease. The patient shared that he is taking care of 10 dogs, 6 cats and a parrot at home. The detailed anamnesis, together with the medical and laboratory tests are of great importance for the timely diagnosis and early initiation of therapy, in order to quickly visual recovery.