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Montabone et al. Neuroimmunol Neuroinflammation 2019;6:7 Neuroimmunology and
DOI: 10.20517/2347-8659.2019.09 Neuroinflammation

Case Report Open Access

Bartonella henselae neuroretinitis in a patient without
cat scratch

Claudia Montabone , Domizia Vecchio , Stela Vujosevic , Stefano De Cillà , Roberto Cantello 1,2
1,2
1
3
3
1 Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara 28100, Italy.
2 Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Department of Health Sciences, University of Piemonte Orientale,
Novara 28100, Italy.
3 Ophthalmology Unit, Department of Health Sciences, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara 28100, Italy.
Correspondence to: Dr. Domizia Vecchio, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale,
Corso G. Mazzini 18, Novara 28100, Italy. E-mail: domizia.vecchio@gmail.com

How to cite this article: Montabone C, Vecchio D, Vujosevic S, De Cillà S, Cantello R. Bartonella henselae neuroretinitis in a patient
without cat scratch. Neuroimmunol Neuroinflammation 2019;6:7. http://dx.doi.org/10.20517/2347-8659.2019.09

Received: 5 Mar 2019 First Decision: 26 Mar 2019 Revised: 2 Apr 2019 Accepted: 2 Apr 2019 Published: 24 Apr 2019
Science Editor: Athanassios P. Kyritsis Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Abstract
Neuroretinitis is characterized by optic disc swelling with macular star, and affects 1%-2% of the patients with Bartonella
henselae infection. This condition needs to be considered in the differential diagnosis of unilateral optic neuropathy in
young adults. A 44-year-old woman presented with a progressive visual loss in right eye that was described as a central
scotoma with altered color perception. Medical history was negative except for Hashimoto’s thyroiditis. The examination
evidenced a relative afferent pupillary defect in right eye and marked papillary oedema involving the macular region. Brain
and orbits magnetic resonance imaging were normal, and fundoscopy showed star-shaped hard exudates. Autoimmune and
infective screening revealed IgM and IgG antibodies against Bartonella henselae, suggesting for recent cat-scratch disease.
She was treated with high-dose intravenous steroids and doxycycline. One month later she fully recovered, and she had
no relapses. We diagnosed a Bartonella henselae neuroretinitis (finally the patient recalled she had stroked stray cats, not
being scratched). In conclusion time course and absence of pain differentiate neuroretinitis from other optic neuropathies.
Fundoscopic image of macular star is a clue for diagnosis, and visual recovery is usually excellent.

Keywords: Neuroretinitis, optic neuropathy, bartonella henselae, cat-scratch disease

INTRODUCTION
Neuroretinitis is a rare inflammatory optic neuropathy with direct involvement or autoimmune activation
against the optic nerve. The inflammation of the optic disc vasculature causes exudation of fluid into the

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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