Abstract Details

Title An atypical case of Ocular Bartonellosis without feline exposure responding to glucocorticoid treatment

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) Neuro-ophthalmology/Neuro-otology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 019

Background

Cat-scratch disease (CSD) caused by B. henselae, typically presents with fever and lymphadenopathy after contact with infected cats. Diagnosis is made by clinical features and positive serology. Rarely, neuroretinitis can be seen in CSD spectrum of manifestations. Optic disc edema with macular star is the typical feature on fundus exam but it may take several weeks to develop.

Objective Report clinical, ophthalmologic and imaging features of an neuroretinitis with bartonella infection.

Design/Methods Case report.

Results 28-year-old male with 1-week of acute onset visual loss centrally in left eye accompanied by pain with eye movement, preceded by 2-day of fever up to 104^oF. No history of feline contact reported except possible contacting to racoons. Exam revealed no lymphadenopathy, vision loss centrally on left with a relative afferent pupillary defect, severe optic-disc edema without macular exudates. MRI revealed subhyaloid fluid collection in posterior globe overlying optic disc without enhancement of the optic nerve. MRI brain, cervical and thoracic spine were reported normal. Labs revealed slightly elevated CRP and ESR. Serum anti-AQP4 and anti-MOG antibodies were negative. Cerebral spinal fluid showed white blood cells of 14/ccm (69% lymphocytes), normal protein, negative oligoclonal bands and meningitis/encephalitis panel. He was initially treated with intravenous solumedrol 1g daily. Subjective improvement in peripheral vision noted by the patient by day 5. Serum B. Hensalae antibodies resulted positive; IgM >1:20 (normal <1:20) and IgG 1:4096 (normal <1:128), which support a diagnosis of Bartonella-related neuroretinitis. Treatment with Doxycycline and rifampin were initiated.

Conclusions Our case emphasizes the importance of considering neuroretinitis in patients presenting with unilateral vision loss with disc edema along with optic neuritis in the setting of bartonella infection, as a history of exposure to cats may be absent, and the classic macular star may not present in initial examination.

Authors/Disclosures
Silu Lu, MD, PhD (Piedmont Atlanta Hospital) PRESENTER	Dr. Lu has nothing to disclose.
Manasa Gunturu, MD (University of MS Medical Center)	Dr. Gunturu has nothing to disclose.
Juebin Huang, MD, PhD (University of Mississippi Medical Center)	Dr. Huang has nothing to disclose.
Tiffany H. Pike-Lee, MD (University of Mississippi Medical Center)	Dr. Pike-Lee has nothing to disclose.