Self-limiting isolated choroidal granuloma with serous retinal detachment: atypical cat scratch disease without feline exposure

Abstract

Abstract Background The ocular manifestations of cat scratch disease (CSD) are diverse. We report a rare case of isolated choroidal granuloma with serous retinal detachment (SRD) secondary to Bartonella henselae infection in a patient without feline exposure. Case presentation A retrospective analysis of a 38-year-old female presenting in March 2024 with unilateral visual impairment and metamorphopsia. Diagnostic evaluations included multimodal imaging (spectral-domain optical coherence tomography [SD-OCT], fluorescein angiography [FA], indocyanine green angiography [ICGA]), and serologic testing. Ocular examination revealed a yellowish-white subretinal lesion with associated SRD superotemporal to the optic disc. SD-OCT demonstrated a dome-shaped choroidal elevation with homogeneous hyporeflectivity and subretinal fluid. FA showed late hyperfluorescence of the lesion, while ICGA revealed persistent hypofluorescence. Serologic testing confirmed elevated Bartonella henselae IgG titers (1:256). The patient had no systemic symptoms or history of feline contact and initially received systemic steroids, topical anti-inflammatory/antibiotic agents, and traditional Chinese medicine. All treatments were discontinued after 24 h, and the lesion subsequently resolved with complete resolution of subretinal fluid and best-corrected visual acuity (BCVA) recovery to 20/20. Conclusion Ocular bartonellosis may manifest as an isolated choroidal granuloma with vision-threatening SRD, even in the absence of feline exposure. Multimodal imaging and serologic testing are critical for diagnosis. The condition may resolve spontaneously without targeted antimicrobial therapy for Bartonella infection, even in the absence of anti-inflammatory therapy.