[Visual impairment related to an isolated paracentral cotton wool spot revealing an atypical presentation of Bartonella henselae retinitis].

Abstract

Cat scratch disease is a bacterial infection due to Bartonella henselae. The microbial agent is most frequently transmitted to humans through a scratch or bite of an infected cat. Ocular involvement occurs in approximately 6% of human infections. We report the case of a healthy 27-year old patient presenting with unilateral scotoma. Multimodal imaging revealed an isolated cotton wool spot (CWS) with no other inflammatory signs on ophthalmological examination. Medical history was unremarkable, although the patient reported living with a cat. Biological and cardiovascular evaluations were normal, except for evidence of recent Bartonella henselae infection. Follow up showed significant resolution of the CWS under antibiotic treatment along with a reduction of the subjective scotoma. Cat scratch disease may cause different ocular manifestations such as uveitis, choroiditis, neuroretinitis, Parinaud oculoglandular syndrome, exudative maculopathy or retinal vascular occlusions. Based on our literature review, an isolated CWS as the sole sign of cat scratch disease is a very rare presentation. Eye care professionals should be aware of this atypical presentation in order to investigate and treat properly those patients.