First Author: O.Budakoglu TURKEY
Co Author(s): M.P. Cakar Ozdal 0 0 0 0 0 0 0 0 0
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To present a case report of cat scratch neuroretinitis with severe vision loss but no other symptoms like fever and lymphadenopathy.
A healthy 19years old male referred to the clinic with painless blurred vision in the right eye for five days.
There were no associated systemic symptoms. Physical examination showed axillary temperature of 37.2°C. There were not any skin lesions, cervical, axillary or inguinal adenopathies noted but only a history of cat bite two weeks ago.. Visual acuity was counting fingers at 2 meters in the right eye and 1.0 in the left. Anterior segment examination was normal in both eyes. Afferent pupillary defect was present in the right eye. In posterior segment examination a white-gray vascularized mass extending off the optic disk and stellate maculopathy was detected. On optic coherens tomography (OCT) imaging a subretinal fluid was found at the fovea. On initial findings (erythrocyte sedimentation rate (ESR: 8 mm) and C-reactive protein (CRP: 0.3 mg/dl) antibiotic therapy with azythromycin and trimethoprim/sulfamethoxazole,was started for potential toxoplasmosis . Several days later (with negative bacteriology, tuberculosis, visual evoked potential alteration) oral prednisone (48mg/day) was added to therapy. After serological studies (HSV-I, HSV-II, adenovirus, CMV, VDRL and toxoplasma) were negative but immunofluorescence for Bartonella henselae Ig M was positive, azythromycin was ended and doxycycline (2X100mg/day) was first prescribed. Visual acuity increased to 0.1 on the second day of therapy but improvement stopped at the first week so rifampicin (2X300mg/day) was added to therapy.
This treatment was maintained for 6 weeks. Steroid was gradually reduced. After six weeks of treatment visual acuity was 0.8 in the right eye and subretinal fluid was resorbed, optic disc edema decreased in OCT.
Cat scratch neuroretinitis may cause severe visual loss and if treatment with doxycycline does not suffice to improve the vision, rifampicin may be added to therapy.