Posterior Scleritis Secondary to Cat Scratch Disease: A Case Report

Purpose: To report an unusual association between posterior scleritis and cat scratch disease.

Design: Observational case report.

Methods: Review of the clinical, laboratory, photographic, angiographic, OCT scans, ultrasound and orbital MRI records of a patient with posterior scleritis secondary to cat scratch disease.

Results: A 44- year- old female patient, with no history of inflammatory or systemic diseases, developed a rapid progressive loss of vision in her left eye associated with mild pain and redness. Best corrected visual acuity was at 8/20 in the left eye and 20/20 in the right eye. The mobilization of the eye ball was remarkably painfull. There was no afferent pupillary defect. Slitlamp examination showed a conjunctival hyperemia and a mild inflammation of the anterior chamber. Fundus examination revealed optic disc edema and choroidoretinal folds at the posterior pole. The right eye was normal. B- mode ultrasound examination revealed a thickened sclera with T-sign. Fluorescein angiography showed early hyperfluorescence of the optic disc and highlighted the choroidoretinal folds. OCT scans showed continuous undulations of the retina layers. Mantoux skin test result was negative. Initial laboratory tests revealed a biological inflammatory syndrome and a negative ANA and rheumatoid factors. A review by a specialist in rheumatology and internal medicine was unremarkable. The patient was treated then with oral corticosteroids. This resulted in the extension of both optic disc edema and choroidoretinal folds. Intensive workup revealed immunoglobulin M againt Bartonella Hanselae responsable of the cat scratch disease. Doxycycline was started and corticosteroids were tapered off. At the second week’s control, both optic disc edema and macular folds had completely resolved.

Conclusion: Posterior scleritis due to cat scratch disease is rare. Antibiotic treatment is recommended to ensure a good visual outcome.