Título / Title

ATYPICAL CASE OF BARTONELLA HANSEALAE RETINITIS - MULTIMODAL RETINAL EVALUATION AND FOLLOW UP.

Introdução / Purpose

Cat scratch disease (CSD) is caused by a gram negative bacteria Bartonella spp. that may present many ophthalmological signs and symptoms.
The most common CSD in posterior ocular segment manifestation is neurorretinitis, but are reported uveitis, optic disc granuloma, vasculitis, vascular occlusion, acute multifocal inner retinitis, retinal white dot syndrome, focal choroiditis, serous detachment and acute endophthalmitis.

Material e Método / Methods

Case report of a female patient with atypical retinal presentation and with its follow up with multimodal retinal exams.

Resultados / Results

Female patient with 26 years old with complain of headache and visual blurring in the past two weeks. She denied similar previous episodes and associated factors. She denied antecedents and refers previous contact with cats.
Inicial visual acuity of 20/20 in both eyes and she presented optic disc with blurred margins, diffuse vascular tortuosity and engorgement and multiples white lesions.
AGF showed in both eyes vasculitis and late hyperfluorescence in optic disc and retinal lesions with hyperfluorescent ring and hypofluorescent center.
SS OCT and OCTA showed normal retinal layers, retinitis and retinal infarct in left eye.
3 months after she presented self improvement of retinal findings

Discussão e Conclusões / Conclusion

We report an extensive systemic evaluation to elucidate diagnosis of a female patient with vasculitis, retinitis and neuritis. Although this patient had epidemiology of CSD, she didn’t presented classical Parinaud presentation nor Neurorretinitis with macular star.
This case is an example of self improvement of symptoms and retinal lesions without antibiotic treatment. Hypothesis to the self improvement of CSD may be due to disease natural history, misdiagnosis etiology and corroborate to low evidence to support treatment.
Multimodal retinal evaluation helps to better understand CSD posterior segment disease and its multiple possible presentations and helps to better follow up these patients

Palavras Chave

Retina, Multimodal exams, Bartonella