OCULAR BARTONELLOSIS AS AN ISOLATED MANIFESTATION OF DISEASE IN A YOUNG CHILD: A CASE REPORT

Abstract

Cat-scratch disease is caused by an anaerobic gram-negative bacillus, difficult to diagnose and with a broad clinical spectrum. We present the case of a 3-year-old male child, always accompanied by his mother at appointments. The onset of left eye pain, pruritus and hyperemia began just over two months earlier, when his mother sought care at a pediatric emergency department. At that time, lubricating eye drops were prescribed, but due to lack of clinical improvement, she then consulted an ophthalmologist. On ophthalmologic examination, the left eye showed posterior uveitis, ocular hyperemia and decreased visual acuity. Fundoscopy and retinography of the same eye described a subretinal granulomatous lesion with perilesional vascular changes and retinal edema involving the entire posterior pole. The optic disc of the left eye was also hyperemic, and ocular ultrasound of the left eye showed retinal detachment. The right eye had no abnormalities. In view of these findings, the specialist prescribed a combined eye drop with Dorzolamide Hydrochloride and Timolol Maleate, in addition to referral to a pediatric infectious disease specialist. The infectious disease evaluation found no fever or lymphadenopathy and immediately requested serologies for syphilis and human immunodeficiency virus (HIV), both negative; serologies for toxoplasmosis and toxocariasis with IgM and IgG, also negative; and rheumatologic tests such as C-reactive protein (CRP), rheumatoid factor, and antinuclear factor – all negative. Once household contact with a cat and licking by the animal were confirmed, anti-Bartonella antibodies were requested, and results were negative for IgM but positive for IgG with a titer of 1:320, confirming ocular involvement by Bartonella. Appropriate treatment is currently underway with sulfamethoxazole-trimethoprim associated with rifampin as antimicrobials for 4 consecutive weeks, and systemic corticosteroid therapy during the first 14 days. The first follow-up visit for reassessment has not yet occurred. There are two main ways to diagnose Bartonella infection: by serologies, as in this case, or via polymerase chain reaction (PCR), which is less available and more expensive. Thus, a high degree of clinical suspicion is required and, consequently, greater medical knowledge production on this ocular disease, which remains largely limited to case reports and case series.