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Sofia Bota1, Sandra Jacinto1, Cristina Ferreira3, Ana Sofia Santos4, Luís Varandas1, Catarina Gouveia1

1 - Pediatric Infecciology Unit, Hospital Dona Estefânia CHLC, Lisboa, Portugal
2 - Pediatric Neurology Unit, Hospital Dona Estefânia CHLC, Lisboa, Portugal
3 - Ophtalmology Unit, Hospital Dona Estefânia CHLC, Lisboa, Portugal
4 - Center for Vectors and Infectious Diseases Research, National Institute of Health Dr Ricardo Jorge, Águas de Moura, Portugal

-       5th Congress of the European Academy of Paediatric Societies (EAPS), 17-21/10/2014, Barcelona, Espanha
-       Poster
-       Arch Dis Child 2014;99:A519 (Resumo)

Introduction:Cat-scratch disease (CSD)-neuroretinitis (CSDN) is an unusual pathology in immunocompetent individuals (1-2% of CSD). It typically presents with sudden vision loss following a febrile illness.

Case Report:A 10 year-old healthy girl presented with fever, headache, vomits and abdominal pain for 48 hours. Also, she referred myodesopsias on her right eye. She had daily contact with kittens. Physical examination showed bilateral cervical nodes. At presentation, her ophthalmologic examination revealed a right eye disc swelling with normal visual acuity. One-week later, unilateral sudden diminished visual acuity (RE=2/10) with macular serous detachment was detected.

Blood analysis revealed normal white cell count, increased C-reactive protein (138 mg/L) and erythrocyte sedimentation rate (44mm/h). A lumbar puncture showed pleocytosis (56/uL). Cranial and orbit MRI were normal. Blood and LCR cultures were negative. HIV, herpesviruses, Toxoplasma gondii, Mycoplasma pneumoniae, Borrelia burgdorferi, Mycobacterium tuberculosis, syphilis and autoimmune diseases were excluded.

Serologic test (IFA) for Bartonella spp, in blood and CSF, was positive (antibodies titers: IgM 32; IgG 4096) with negative DNA amplification. She was treated with doxycycline and rifampicin. Moreover, intravenous corticosteroids were added in the first 3 days. She became asymptomatic and right visual acuity was 10/10 after 3 months.

Discussion: The absence of a macular star does not exclude and should not delay the diagnosis of CSDN. Serology remains the most common test to support the diagnosis. The role of antibiotics with or without steroids is not consensual. Still, patients usually have a favorable visual outcome.