Keywords
Cat-Scratch Disease
Bartonella henselae
Child
How to Cite
Abstract
Introduction: infection caused by Bartonella henselae typically presents with fever and subacute regional lymphadenopathy. However, 5% to 25% of cases develop atypical manifestations, such as neuroretinitis.
Case Report: an 8-year-old, previously healthy male presented with a one-week history of decreased visual acuity in the right eye (OD). The patient denied ocular pain, headache, or fever. Uncorrected visual acuity (UCVA) was 4/10 in the OD and 10/10 in the left eye (OS). Fundus examination of the OD revealed optic disc edema, predominantly inferior, vascular tortuosity, and a clear vitreous. Serologies for cytomegalovirus, rubella, toxoplasmosis, and syphilis were negative. Brain MRI demonstrated right optic disc protrusion. Forty-eight hours after admission, visual impairment persisted, and OD funduscopy showed optic disc edema, tortuous vessels, radial macular folds, retinitis foci, peripheral vascular sheathing, and an impending macular star. Probable B. henselae neuroretinitis was suspected, and a history of frequent contact with kittens was subsequently identified. B. henselae IgG and IgM serologies were reactive (titers ≥ 1:1024). Treatment with doxycycline and rifampin was initiated. Following partial improvement, a full six-week course of antibiotics was prescribed. Clinical outcome was favorable, reaching a UCVA of 10/10 in the OD three weeks after initiating therapy.
Conclusions: ocular involvement in B. henselae infection can occur via hematogenous dissemination or conjunctival inoculation. Neuroretinitis affects 1% to 2% of patients; diagnosis is clinical-epidemiological and confirmed by laboratory testing. Antibiotic management in immunocompetent individuals remains controversial. In patients presenting with decreased visual acuity, taking a detailed history—specifically inquiring about contact with cats—and performing a thorough ophthalmologic examination are crucial for accurate diagnosis and timely treatment.
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