A star in the eye: cat scratch neuroretinitis


Key Clinical Message

Neuroretinitis is one of the atypical presentations of Cat scratch disease (CSD). Fundoscopy showed star pattern macular exudates. CSD should be considered in patients who present with blurry vision and typical fundoscopic findings.

Cat scratch disease (CSD) is a rare infection caused by Bartonella henselae. Neuroretinitis is an atypical presentation of CSD [1]. A 33-year-old woman presented with left jaw pain and swelling to the primary care physician's office and received treatment for a possible dental infection. Over the next few days, she developed blurry vision in the left eye along with photophobia and was referred to the ophthalmologist. She worked in a public park and confirmed exposure to domestic cats. On examination, it was observed that her pupils were equal and briskly reactive to light; extraocular movements were intact. Right eye examination was normal. Left eye visual acuity was 20/50. She had a mild reduction in the intensity of her color vision on the left, with disk edema and typical macular exudates in a star pattern on fundoscopy (Fig. 1). Diagnosis of CSD was confirmed with IgM antibody titers of 1:1024. She was treated with rifampin and doxycycline for 6 weeks [2]. Within 3 weeks of therapy, her visual acuity improved and color vision intensity returned to baseline. Complete resolution of symptoms, fundoscopic changes, and antibody titers were noted at 3 months.

Figure 1.

Macular star pattern exudates in the left eye.

Conflict of Interest

None declared.