Unusual symptoms found in cat scratch disease patients

Vitreous haemorrhage with retinal vaculitis and isolated central retinal artery occlusion (CRAO) were reported in the eyes of patients with cat scratch disease (CSD), according to an investigation in International Ophthalmology.

CSD, caused by proteobacterium Bartonella henslae, has presented ocular complications including blurred vision and partial visual loss.

Dr Antonio Pinna et al., St Orsola-Malpighi University Hospital, Italy, investigated the cases of 2 CSD patients. One case involved a 42-year-old patient who had blurred vision for five days, with visual acuity in the right eye at 20/25. Fundus examination demonstrated mild vitreous haemorrhage, diffuse retinal haemorrhage and multiple vasculitic occlusions in the mid-peripheral retina. Immunoglobulin (Ig)M and IgG in B. henslae. Oral anzithromycin was administered for 8 days.

The second case involved a 66-year-old patient with systematic hypertension and hypercholerterolemia and reported visual loss in the left eye. Fluorescein angiography and fundus evaluation revealed CRAO and serologic testing confirmed the presence of IgM and IgG antibodies. The patient was given oral anzithromycin for 6 days.

One month after treatment the patient in case 1 had 20/20 vision in the right eye and the vitreous and retinal haemorrhages were resolved. The patient in case 2 had visual acuity in the left eye to the level of hand motion.

Ophthalmologists should always be aware of unusual ocular manifestations in CSD, especially vitreous haemorrhage with retinal vasculitis and isolated CRAO.