Shannon Bertone, COA, and Steve R. Witkin, MD, Maine Eye Care Associates, Waterville, Maine.
A 39-year-old man presented with a two-day history of decreased central vision and distortion in the right eye, and a history of amblyopia in the left eye. His uncorrected visual acuity was 20/200-1 in the right eye, and CF 6’ in the left eye. Slit-lamp exam was within normal limits. Fundus examination of the right eye showed optic nerve edema and macular edema, as well as a yellowish choroidal lesion supero-nasal to the fovea. Optical coherence tomography testing of the right eye revealed a central foveal thickness of 549 µm with extensive subretinal fluid. Fluorescein angiography showed extensive late leakage from the optic nerve and minimal leakage from the choroidal lesion.
The patient was started on 100 mg of oral doxycycline twice daily for presumed cat-scratch disease. A complete blood count with differential and sedimentation rate returned within normal limits. However, titers of antibodies to cat-borne pathogens were elevated: Bartonella/IgG at 1:128 and Toxoplasma at 45IU/mL.
Visual acuity at four days’ follow-up was 20/60+1 in the right eye. The photo was taken at 10 days follow-up with visual acuity at 20/50-1. The patient had obtained two cats two months prior to presentation and reported sustaining multiple scratches.Blink is edited by Richard E. Hackel, MA, CRA, FOPS.