Bartonella henselae neuroretinitis in a patient without cat scratch

• 作者: Claudia Montabone Domizia Vecchio Roberto Cantello Stefano De Cillà Stela Vujosevic
• 来源期刊: 神经免疫与神经炎症（英文版）
• 年，卷（期）: 2019,（4）
• 所属期刊栏目: Case Report
• 页码范围: 4-10
• 页数: 7页
• 语种: 英文
• DOI: 10.20517/2347-8659.2019.09

摘要

Neuroretinitis is characterized by optic disc swelling with macular star, and affects 1％-2％ of the patients with Bartonella henselae infection. This condition needs to be considered in the differential diagnosis of unilateral optic neuropathy in young adults. A 44-year-old woman presented with a progressive visual loss in right eye that was described as a central scotoma with altered color perception. Medical history was negative except for Hashimoto's thyroiditis. The examination evidenced a relative afferent pupillary defect in right eye and marked papillary oedema involving the macular region. Brain and orbits magnetic resonance imaging were normal, and fundoscopy showed star-shaped hard exudates. Autoimmune and infective screening revealed IgM and IgG antibodies against Bartonella henselae, suggesting for recent cat-scratch disease. She was treated with high-dose intravenous steroids and doxycycline. One month later she fully recovered, and she had no relapses. We diagnosed a Bartonella henselae neuroretinitis (finally the patient recalled she had stroked stray cats, not being scratched). In conclusion time course and absence of pain differentiate neuroretinitis from other optic neuropathies. Fundoscopic image of macular star is a clue for diagnosis, and visual recovery is usually excellent.