What is it about?
This is the question part of a clinical photo quiz. A healthy 20-year-old student was admitted with two days of painless loss of vision in both eyes, fever, back pain and malaise. He owned a cat and two dogs and often went climbing and trekking along the Italian-Slovenian border. He had a swollen lymph node in the right armpit and mildly raised inflammation markers. Eye examination with fundoscopy and fluorescein angiography revealed characteristic changes of the retina and optic nerve. Readers are invited to work out the diagnosis from the clinical picture and images before reading the answer: neuroretinitis caused by Bartonella henselae, the agent of cat-scratch disease.
Featured Image
Photo by Amanda Dalbjörn on Unsplash
Why is it important?
Sudden vision loss with fever in a young person is alarming and has many possible causes. This quiz trains clinicians to connect key clues - cat ownership, swollen lymph nodes and specific retinal findings - to a treatable infection, enabling early diagnosis and targeted antibiotic therapy.
Perspectives
Photo quizzes are one of my favourite teaching formats: they recreate the reasoning we do at the bedside. This case, managed with our ophthalmology colleagues in Trieste, shows how a simple question about pets can unlock a diagnosis.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Question: Fever and Vision Loss in an Immunocompetent 20-Year-Old Male, Clinical Infectious Diseases, January 2017, Oxford University Press (OUP),
DOI: 10.1093/cid/ciw716.
You can read the full text:
Contributors
The following have contributed to this page
