This 52YO female presented with one week of bilateral vision loss. She has multiple cats at home. Vision was 20/80 OD and counting fingers OS.
Optos color RG imaging shows an area of inferonasal macular inner retinal opacification OD, and a superiorly swollen left optic nerve with a superonasal macular lipid star.
Fluorescein angiography shows early blockage with late staining of the retinal lesion OD with an adjacent area of vasculitis. Marked optic nerve leakage is seen OS.
Bartonella henselae antibody testing was positive for both IgG >1:1024 and IgM 1:126. She was subsequently lost to follow-up.
Learning Points:
Bartonella henselae is the bacterium associated with cat scratch disease. It is transmitted from cat fleas carrying the bacterium or from flea feces that can be present on the cat’s claws/teeth, and transferred to humans from a cat scratch, lick, or bite. Common systemic findings include fever, malaise, and progressive lymphadenopathy. These findings usually occur within 1-2 weeks of a cat scratch/bite. Ocular effects primarily include neuroretinitis with rare cases of Parinaud’s ocular glandular syndrome, or, as in our patient’s case, chorioretinitis with vasculitis.
