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November/December 2010

 
This Month's BLINK
Cat-Scratch Neuroretinitis
Written by Randy H. Kardon, MD, PhD, University of Iowa Hospital and Clinics, Iowa City.
Edited by Michael P. Kelly, CPT.
 
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(PDF 242 KB)

Blink_1110450

A healthy 17-year-old Caucasian male presented with acute decrease in vision in the right eye to 20/300, a relative afferent pupillary defect and a cecocentral scotoma. Exami­nation revealed optic disc edema with a retinal infiltrate and fluid adjacent to the nerve continuous with edema in the macula. The optic nerve appearance and the vision in the left eye were normal.

The patient was suspected to have neuroretinitis in the right eye, but on presentation there was no macular star figure, which is characteristic of the disease. He had pet cats but no clear his­tory of being exposed to a recent cat scratch or bite. A serum titer for antibody IgG to Bartonella was mildly elevated to a titer of 1:64 on presentation. A convalescent titer five weeks later (taken at the time of this photograph) had risen to 1:128, consistent with a diagnosis of neuroretinitis. As the retinal fluid and optic disc edema resolved, the cecocentral scotoma resolved. Visual acuity in the right eye had improved to 20/50. At that time, a well-defined macular star figure was present due to the resolution of the fluid, leaving exudates forming the specific star pattern.

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