C Tolou1, L Mahieu1, G Martin-Blondel2, P Ollé1, F Matonti3, S Hamid1, X Benouaich4, A Debard5, M Cassagne6, V Soler7. 1. Unité de rétine, consultation d'ophtalmologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France. 2. Service de maladies infectieuses et tropicales, CHU de Toulouse, 31059 Toulouse, France; Inserm U1043, CNRS UMR 5282, centre de physiopathologie de Toulouse-Purpan, 31059 Toulouse, France; Université Toulouse III, 31000 Toulouse, France. 3. Service d'ophtalmologie, hôpital de la Timone, université d'Aix-Marseille, AP-HM, 13385 Marseille, France; Centre d'ophtalmologie, clinique de l'Union, 31240 Saint-Jean, France. 4. Laboratoire GR2DE, EA4555, centre de physiopathologie de Toulouse-Purpan, 31059 Toulouse, France. 5. Service de maladies infectieuses et tropicales, CHU de Toulouse, 31059 Toulouse, France. 6. Unité de rétine, consultation d'ophtalmologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France; Université Toulouse III, 31000 Toulouse, France; Laboratoire GR2DE, EA4555, centre de physiopathologie de Toulouse-Purpan, 31059 Toulouse, France. 7. Unité de rétine, consultation d'ophtalmologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse cedex, France; Université Toulouse III, 31000 Toulouse, France; Laboratoire GR2DE, EA4555, centre de physiopathologie de Toulouse-Purpan, 31059 Toulouse, France. Electronic address: vincesoler@yahoo.fr.
Abstract
INTRODUCTION: Cat-scratch disease (CSD) is a systemic infectious disease. The most well-known posterior segment presentation is neuroretinitis with a macular star. In this study, we present a case series emphasising the heterogeneity of the disease and the various posterior segment manifestations. MATERIALS AND METHODS: A retrospective case series of consecutive patients presenting with posterior segment CSD, over a 5-year period (2010 to 2015), at two ophthalmological centres in Midi-Pyrénées. RESULTS: Twelve patients (17 eyes) were included, of whom 11 (92%) presented with rapidly decreasing visual acuity, with 6 of these (50%) extremely abrupt. CSD was bilateral in 5 (42% of all patients). Posterior manifestations were: 12 instances of optic nerve edema (100%), 8 of focal chorioretinitis (67%) and only 6 of the classic macular edema with macular star (25% at first examination, but 50% later). Other ophthalmological complications developed in three patients; one developed acute anterior ischemic optic neuropathy, one a retrohyaloid hemorrhage and one a branch retinal artery occlusion, all secondary to occlusive focal vasculitis adjacent to focal chorioretinitis. CONCLUSION: Classical neuroretinitis with macular star is not the only clinical presentation of CSD. Practitioners should screen for Bartonella henselae in all patients with papillitis or focal chorioretinitis.
INTRODUCTION: Cat-scratch disease (CSD) is a systemic infectious disease. The most well-known posterior segment presentation is neuroretinitis with a macular star. In this study, we present a case series emphasising the heterogeneity of the disease and the various posterior segment manifestations. MATERIALS AND METHODS: A retrospective case series of consecutive patients presenting with posterior segment CSD, over a 5-year period (2010 to 2015), at two ophthalmological centres in Midi-Pyrénées. RESULTS: Twelve patients (17 eyes) were included, of whom 11 (92%) presented with rapidly decreasing visual acuity, with 6 of these (50%) extremely abrupt. CSD was bilateral in 5 (42% of all patients). Posterior manifestations were: 12 instances of optic nerve edema (100%), 8 of focal chorioretinitis (67%) and only 6 of the classic macular edema with macular star (25% at first examination, but 50% later). Other ophthalmological complications developed in three patients; one developed acute anterior ischemic optic neuropathy, one a retrohyaloid hemorrhage and one a branch retinal artery occlusion, all secondary to occlusive focal vasculitis adjacent to focal chorioretinitis. CONCLUSION:Classical neuroretinitis with macular star is not the only clinical presentation of CSD. Practitioners should screen for Bartonella henselae in all patients with papillitis or focal chorioretinitis.