Central Carolina Surgical Eye Associates, P.A.

Case Seven: Acute Neuroretinitis - Cat Scratch Disease

Color Photo of right eye.  Note blurred optic disc margin, macular star and deep creamy yellow choroidal lesions.  Color photo of left eye.  Note partial macular star and small creamy deep choroidal lesions.
Red Free photo of right eye.  Note macular star, multiple choroidal lesions and choriodal folds along the temporal edge of the macular star.

Red Free photo of left eye.  Note partial macular star and a few scattered choroidal lesions.

Early phase FA right eye.  Note full vasculature and patchy choroidal filling. Mid Phase FA right eye.  Note many hyperfluorescent choroidal lesions and dilated disc vessels
Late phase FA right eye.  Note large number of choroidal lesions and optic disc staining Late phase FA left eye.  Note only a few choroidal lesions of varying size.
Mid phase  ICG of right eye highlights the many hypofluorescent  choroidal lesions. Mid phase ICG of the left eye shows that the lesions on FA correspond to the lesions on ICG indicating that they are the same lesions
Late phase ICG of the right eye.  The choroidal lesions appear smaller and well demarcated.  Late phase ICG of the left eye.  Some lesions are hyperfluorescent and some are hypofluorescent


This 21 year old Caucasian man presented with blurred vision and a history of optic nerve edema.  A month prior to the above photos he had ‘Count Fingers Only’ vision in the right eye and 20/200 vision in the left eye.  His blood pressure was normal.  His MRI scan of the brain and lumbar puncture were also normal.  After a course of systemic steroids the vision improved to 20/30 right eye and 20/20 left eye.  Cat Scratch disease was suspected after our examination revealed bilateral macular stars along with creamy colored deep choroidal lesions.  Treatment for Cat Scratch Disease was begun with oral Ciprofloxacin.  Titres for Bartonella henselae were drawn one month after onset of symptoms and were positive (44 EIA units) for IgG but negative for IgM. 
The visual field exam showed an enlarged blind spot in the right eye and a dense paracentral scotoma.  This case of Acute Neuroretinitis is strongly suggestive of Cat Scratch Disease.


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