title: Cat Scratch Disease: Expanded Spectrum.
abstract: BACKGROUND
  To expand the spectrum of ophthalmic manifestations in cat scratch disease.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 7-year-old male was referred for evaluation of his left optic disc after failing vision screening test at school. His visual acuity was 20/20 OD and light perception OS. Fundus examination showed a left optic disc lesion associated with an exudative retinal detachment and vitreous seeding. Ultrasonography revealed a 7 × 7.5 × 3.8 mm lesion with a possible 6.3 mm of retrolaminar extension into the substance of the optic nerve. Brain MRI did not show evidence of optic nerve involvement but revealed a 6-mm nodule of the pineal gland suggestive of a pineoblastoma. Enucleation was performed and histopathology revealed a suppurative granulomatous inflammation suggestive ofBartonellainfection. Upon further questioning, the patient had recent exposure to kittens with areas of cat scratches along both of his arms. He was subsequently referred to and treated with a 2-week course of trimethoprim-sulfamethoxazole and rifampin by the pediatric infectious disease specialist. Repeat brain MRI showed interval total resolution of enlarged pineal gland.Conclusion:Optic nerve granulomas are a rare presentation of cat scratch disease and could potentially masquerade as retinoblastoma.
authors.affiliation: Department of Ophthalmology, Cole Eye Institute, Ohio, USA.
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Aziz
authors.affiliation: Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Plesec
authors.affiliation: Pediatric Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Camille
authors.initials: C
authors.lastname: Sabella
authors.affiliation: Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Unni K
authors.initials: UK
authors.lastname: Udayasankar
authors.affiliation: Department of Ophthalmology, Cole Eye Institute, Ohio, USA.
authors.forename: Arun D
authors.initials: AD
authors.lastname: Singh
keywords: Bartonella; Cat scratch disease; Histopathology; Optic nerve granuloma; Peripapillary angiomatous lesion; Pineal gland; Retinoblastoma