Cat-Scratch Disease Presenting with Neuroretinitis-A Case Report and Review of Literature

目的：單獨以神經視網膜炎表現，就以血清學檢查確診之貓抓病病例。方法：病例報告。結果：一位三十一歲年輕女性，主訴右眼無痛性視力模糊兩天，無全身性症狀。眼底檢查可見右眼有視神經盤水腫，視神經盤前有緻密浸潤，黃斑部呈現輕微水腫。經住院治療一週，右眼黃斑部出現星形病灶。血清檢體逕送疾病管制局，貓抓病IgM抗體結果為陽性，最後確診為貓抓病神經視網膜炎。經類固醇脈衝治療，右眼最佳矯佳視力從起始的0.2，於八週後恢復至0.7。結論：貓抓病為第四類法定傳染病，本案例患者既無貓抓病典型之全身性能狀，亦無貓之接觸史，為鑑別診斷的一大考驗。目前貓抓病的治療方式仍具爭議性，不過全身性類固醇治療讓本案例之眼部發炎得以迅速緩解。

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並列摘要

Purpose: To report a case of serologically proven cat-scratch disease with ocular manifestations of neuroretinitis alone in the absence of systemic symptoms.Method: Case report.Results: A 31-year-old woman presented with unilateral painless blurred vision of right eye (OD) for two days without any other constitutional symptoms. Dilated fundus examination revealed optic disc edema, a dense pre-disc vitreous infiltrate and slight macular edema (OD) as well as a cotton-wool spot (OS). A macular star (OD) developed at 1-week follow-up. Bartonella henselae IgM testing was positive, which confirmed the diagnosis of cat-scratch disease. The patient was treated with steroid pulse therapy with recovery of best corrected visual acuity of right eye from 0.2 initially to 0.7 at 8-week follow-up.Conclusion: Cat-scratch disease neuroretinitis in the absence of typical systemic manifestations and exposure history is rare and clinically challenging in its diagnosis. This case is also noteworthy in its fundus appearance. Treatment is controversial; however, systemic corticosteroids in this patient resulted in quick resolution of ocular inflammation.

並列關鍵字

Bartonella henselae ； cat-scratch disease ； macular star ； neuroretinitis

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Cat-Scratch Disease Presenting with Neuroretinitis-A Case Report and Review of Literature

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