What is it about?
This is the answer to a clinical photo quiz about a healthy 20-year-old man with sudden painless vision loss in both eyes, fever, back pain and a swollen armpit lymph node, who owned a cat and two dogs. The diagnosis was neuroretinitis caused by Bartonella henselae, the bacterium responsible for cat-scratch disease, usually transmitted by scratches or bites from cats. Neuroretinitis is an inflammation of the optic nerve and retina that typically causes swelling of the optic disc and a star-shaped pattern of deposits around the macula. The diagnosis is supported by serology, and treatment with appropriate antibiotics, sometimes combined with steroids, usually leads to good visual recovery.
Featured Image
Photo by Manja Vitolic on Unsplash
Why is it important?
Bartonella is a classic but often forgotten cause of acute vision loss in young people with cat contact. Recognizing the typical retinal picture and asking about pets allows prompt diagnosis and treatment, protecting vision.
Perspectives
This case reminded me that animals are part of every patient history. Together with ophthalmologists in Trieste, we wanted to share images that help clinicians recognize Bartonella neuroretinitis at a glance.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Fever and Vision Loss in an Immunocompetent 20-Year-Old Male, Clinical Infectious Diseases, January 2017, Oxford University Press (OUP),
DOI: 10.1093/cid/ciw717.
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