Abstract

Cat scratch disease (CSD) is caused by a gram-negative bacterium, Bartonella henselae. This uncommon disease is believed to be transmitted by a cat scratch or bite, when the bacterium is present on the cat’s claw or resides in the oral cavity. There are approximately 22,000 cases of CSD diagnosed in the United States annually. Neuroretinitis (NR), which occurs in 1%-2% of CSD cases, is characterized by acute vision loss, optic disc edema, and a macular star. Diagnosis can be aided by fundus examination, optical coherence tomography (OCT), fluorescein angiography (IVFA), and serological testing for B. henselae infection. Cat scratch disease is usually self-limiting; however, oral antibiotics may shorten the duration of the disease. The following case describes a dramatic presentation of a 13-year-old Hispanic female diagnosed with CSNR. The patient reported an earlier skin rash and lymphadenopathy and presented with monocular vision loss. Examination revealed optic disc edema and a macular star in the left eye. The diagnosis was confirmed by positive serology for B. henselae. She was treated with trimethoprim-sulfamethoxazole (Bactrim 400 mg/80 mg tablets) for three weeks. After six weeks, her systemic signs and symptoms resolved. Her visual acuity recovered but visual distortion remained.

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