(BMJ)—A woman in her 40s presented with a 10-day hx of reduced visual acuity in her L eye and a lump in her L axilla. She reported a cat scratch on her L forearm 1 month prior. Exam: optic disc swelling, macular edema, stellate exudate. Positive tender axillary node. What’s the dx?
Toxoplasmosis
Tuberculosis
Cytomegalovirus infection
Sarcoidosis
Bartonella henselae infection
You are correct. A blood test was positive for B. henselae IgG, and classic features of neuroretinitis (optic disc swelling, macular edema, and stellate exudate) were present, confirming the dx. Bartonella neuroretinitis is an ocular manifestation of cat scratch disease. This is a rare infectious disease (4-5.7 cases per 100,000 annually in the U.S.) and is typically associated with regional lymphadenopathy, fever, and malaise. It’s important to ask about hx of cat scratches in patients presenting with neuroretinitis.

BMJ 2021;372:n552