Cat scratch disease with atypical and severe ocular manifestations

Session Details

Session Title: Free Paper Session 10: Uveitis

Session Date/Time: Friday 08/09/2017 | 11:00-12:30

Paper Time: 11:54

Venue: Room 111

First Author: : S.Parreira PORTUGAL

Co Author(s): :    S. Barros   G. Andrade   C. Cavalcanti   B. Carvalho   H. Nascimento                 

Abstract Details

Purpose:

Cat scratch disease is a systemic, self-limited disease secondary to Bartonella henselae infection after contact with infected cats and has been mostly described as a benign condition. Ocular involvement occurs in 5-10% of cases and is the most commonly non-lymphatic organ envolved. Typical presentation of neuroretinitis occurs in 1-2% of patients, usually unilateral and typically in children. Although most studies show benign cases, the objective of this series of cases is to demonstrate the possibility atypical and severe manifestations with poor visual outcome.

Setting:

Department of Uveitis of the Federal University of Sao Paulo, UNIFESP, Brasil.

Methods:

Retrospective study of severe cases of cat-scratch disease with ocular involvement. All patients had complete clinical and ophthalmological evaluation with retinography and angiography when needed. Literature of the last 20 years was revised through Pubmed database for a combination of terms: cat scratch disease, ocular, atypical.

Results:

Six eyes had a confirmed diagnosis of the disease. Two of them were men and four were women, the mean age was 24.8 years [7-45]. All had a history of exposure to cats. The visual acuity in the presentation ranged from no light perception to 20/25. Only one patient presented classic neuroretinitis with the macular star. In two patients, focal areas of retinitis were present and three patients showed peripapillary angiomatous lesions, one with exudative detachment of the retina and one with occlusion of the central artery of the retina. Three patients were treated with doxycycline, and one with clarithromycin and prednisone. Although all patients underwent treatment, 5 in 6 eyes evolved with final visual acuity of 20/40 or less. There were no recurrences.

Conclusions:

Although usually described as a benign condition with spontaneous resolution and good prognosis, the disease may present with unusual manifestations, with poor visual prognosis, such as vascular lesions, serous retinal detachment, retinal vasculitis, vascular occlusions and macular hole. The largest series of cases reported in the literature by Curi et al in 2010 indicates that up to 20% of patients may have visual acuity <20/40 and up to 13% with visual acuity <20/200. The four cases presented here corroborate the possibility of a more aggressive presentation of this disease. The treatment is not consensual although some authors argue that the use of antibiotics and steroids should be used in these cases. Therapy was given to all patients with some benefit, although final visual acuity was still equal or below 20/40 in the majority of involved eyes.

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