A 57-year-old woman reported blurred vision of the left eye with fever and malaise for 3 weeks. Visual acuity was 20/40 with an afferent pupillary defect. The optic nerve was swollen (figure 1A) with a normal macula. Skin abnormalities were evident on her arms (figure 2). Serologic studies indicated recent infection with Bartonella henselae (immunoglobulin M ≥1:20, immunoglobulin G ≥1:1,024). There was complete recovery following treatment with doxycycline and rifampin. It is important for clinicians to identify optic neuropathy associated with cat-scratch disease, which often has a favorable prognosis. Stellate macular exudates are absent in more than 50% of patients.1
Initially noted optic disc swelling (A) improved (B) and eventually resolved with antibiotics (C). Axial (D) and coronal (E) contrast-enhanced T1-weighted MRI showed enhancement at the left optic nerve–globe junction (arrowheads), which is characteristic of cat-scratch disease.2 No brain lesions were present.
Multiple cat-scratch marks with healing papules and pustules on both arms.
AUTHOR CONTRIBUTIONS
Dr. Vodopivec conceived the manuscript, drafted the initial manuscript, revised the manuscript, and created the figures. Dr. Shah was responsible for the care of the patient, including diagnosis and treatment, and revised the manuscript. Dr. Prasad interpreted the MRI findings and revised the manuscript. Dr. Cohen was responsible for the care of the patient, including diagnosis and treatment, conceived the manuscript, drafted the initial manuscript, and revised the manuscript.
STUDY FUNDING
No targeted funding reported.
DISCLOSURE
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Footnotes
Download teaching slides: Neurology.org
- © 2015 American Academy of Neurology
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
