Neuroretinitis caused by Bartonella henselae: case report

Abstract

Cat scratch disease is an infectious disease caused by Bartonella henselae characterized by regional lymphadenopathy and fever.Although it may involve other organs, ocular involvement is rare (5%-10%) and may manifest as neuroretinitis. We present a case ofan 11-year-old patient admitted to the emergency department because of vision loss on the right eye, detected on a vision screeningtest. Ophthalmological evaluation showed disc swelling, peripapillary microhaemorrhages and macular oedema with lipid-richexudates, suggestive of the macular star pattern. Serological studies revealed elevated titre of antibodies to Bartonella henselae. Thepatient was treated with rifampicin and doxycycline, with optimal response. Neuroretinitis is an uncommon manifestation ofBartonella henselae infection and should be suspected in any patient presenting loss of visual acuity, along with the fi nding of discswelling, macular star exudates, and a history of contact with cats. Most patients recover most or all of their pre-infection visual function,however, a small subset of patients with particularly severe neuroretinitis may be left with optic sequelae. There are no randomizedtrials on the eff ectiveness of treatment but antibiotic therapy with rifampicin and doxycycline seems to shorten the course of thedisease and hasten visual recovery.