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Marshall E. Tyler, CRA, FOPS
Wake Forest University
Eye Center

 

The answer to this month’s mystery image:

Macular Star From Cat-Scratch Disease

Again this month: a case of cat-scratch fever. This time, the patient is a 41-year-old female with a complaint of blurry vision with progression to a large central blind spot over the previous two weeks. At initial presentation, her visual acuity was 1/200 in the right eye and 20/15 in the left eye. Visual field testing showed a large central scotoma in the right eye. Dilated fundus examination revealed marked optic disc edema with venous engorgement and a thickened macula in the right eye. A diagnosis of neuroretinitis from Bartonella henselae was eventually made based on clinical history, examination and elevated serum titers.

Five weeks following her initial presentation, the classic appearance of disc edema with a macular star was evident. The high-magnification fundus photograph of the central macula showed thickening with radial exudates in a star pattern.

The patient was treated with oral prednisone, tapered over six weeks. The visual acuity in the right eye was 20/60 at her three month follow-up exam.

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Written by David Gilbert, MD, ophthalmology resident at Wake Forest University. Blink is edited by Richard E. Hackel, MA, CRA, FOPS.