1. Cat Scratch Disease Rupesh Agrawal, Carlos Pavesio
Moorfields Eye Hospital,
NHS Foundation Trust,
London, United Kingdom

2. Ocular History
40 year male
OD :blurry vision and floaters since 3 weeks
no complaints of pain, redness
first episode
no history of trauma

3. General History no history of viral illness, fever, headache
denies any history of camping, tick bites, other exposure
BUT he was bitten by his girlfriend’s cat 3 weeks ago
history of Rheumatoid Arthritis
on Prednisolone 10mg/day

4. First Presentation - Ocular Examination
Visual acuity
OD -6/24, OS -6/6 AC
quiet, no cells, no flare: OU
lens clear OU
anterior vitreous
trace cells OD, clear OS

5. First Presentation - Fundus OD
macular star and disc edema with peripapillary hemorrhages

6. First Presentation - Fundus OS
normal ocular fundus

7. First Presentation Red free photographs
RE- presence of lesions suggestive of macular star and disc hyper-fluorescence

8. First Presentation - FFA OD
Presence of hyperfluorescent lesions temporal to fovea and disc hyperfluorescence

9. Differential Diagnosis
Cat scratch disease
Sarcoidosis
Toxoplasmosis
Presumed ocular tuberculosis

10. First Presentation - Investigations
CBC, U/E, LFT’s
ACE
Borrelia, toxoplasmosis
QuantiFERON-gold
Syphilis serology
Bartonella titer – positive IgM
Bartonella henselae 2560 ( normal: <1:20)
Bartonella quintana 640 ( normal: <1:20)
Norm is <320

11. Diagnosis Cat scratch Disease based on:
symptoms: generalized ache, malaise, anorexia, fever
serology
typical clinical findings:
focal white retinal lesion involving the inner half of the retina +/- vitreous
optic nerve head swelling, associated angiomatous proliferation of capillaries

12. Treatment
Doxycycline
100mg BD
for 2 weeks
no additional corticosteroids

13. Follow up – After 2 Months
Resolution of neuroretinitis lesions over period of two months

14. Conclusion Spontaneous resolution within several weeks or months
Treatment only in significant vision loss or for patients with immunosuppression
Doxycycline, Ciprofloxacin, prednisolone are important drugs in the management of neuroretinitis
Is „under“ in point 2 ok?