Suspecting Optic Neuritis, Diagnosing Bartonella Cat Scratch Disease

BACKGROUND: Bartonella cat scratch disease is classically a febrile illness, in conjunction with lymphadenopathy and cat exposure. OBJECTIVE: To report 2 atypical cases of cat scratch disease with only blurred vision and headache. DESIGN: Case reports. SETTING: University hospital. PATIENTS: Two young adults with unilateral blurred vision, retro-orbital headache, and a positive Bartonella henselae serologic result, without fever or lymphadenopathy. MAIN OUTCOME MEASURES: Funduscopic examination and B henselae serologic findings. RESULTS: Both patients had optic disc swelling and a macular star on funduscopic examination, suggestive of infection. Infection was confirmed by positive serologic results. CONCLUSION: Cat scratch disease should be considered in the differential diagnosis for patients presenting with blurred vision and headache, even in the absence of fever, lymphadenopathy, or both.