RETINAL AND CHOROIDAL MANIFESTATIONS OF CAT-SCRATCH DISEASE

Objective: The ability to diagnose cat-scratch disease (CSD) has been facilitated greatly by the recent isolation and characterization of Ba rtonella henselae (formerly genus Rochalimaea) and Afipia felis and by the subsequent development of specific enzyme-linked immunosorbent as say (ELISA) serologic tests. This study will help define the patterns of posterior segment ocular involvement in patients with confirmed CSD . Design: The study design is a retrospective case study and literatur e review. Participants: Two consecutive patients with acute visual los s from retinal manifestations of CSD participated. Interventions: The diagnosis was confirmed by B. henselae ELISA testing. Patients underwe nt extensive medical and ophthalmic investigations to exclude other ca uses of retinal and choroidal disease. Ophthalmic investigation includ ed fluorescein angiography and visual field testing. One patient recei ved antibiotic therapy with cefotaxime, then with ciprofloxacin, and w as treated with oral prednisone. The other patient was improving for s everal weeks before oral doxycycline was given. Main Outcome Measures: The clinical syndromes observed were studied over time using visual a cuity, visual field, and clinical findings. Data were collated with ca ses from the literature. Results: Unilateral neuroretinitis and an unu sual macular retinitis developed in patient 1, as did bilateral small intraretinal white spots and a unilateral choroidal infiltrate that co ntinued to develop while the patient received antibiotic treatment. Pa tient 2 had a branch arteriolar occlusion in relation to a perivascula r retinal infiltrate and a few small, bilateral, intraretinal white sp ots. There was gradual resolution with visual improvement while the pa tient received the antibiotic treatment, although therapeutic efficacy could not be determined. Patient 1 also received oral corticosteroids . A detailed analysis of the literature placed these findings in conte xt. Conclusions: An unusual, well-defined retinal opacification with f eatures of both multiple retinal arteriolar occlusions and a low-grade retinitis was described. Several features also may occur in posterior segment CSD, including neuroretinitis, a retinal white spot syndrome, and focal choroiditis.