Paradoxical response in ocular bartonellosis

Cat scratch disease is an infectious disease caused by the bacteria Bartonella henselae [1] and is transmitted by cat scratches or exposure to cat saliva. The spectrum of its ocular manifestations includes Parinaud's oculoglandular syndrome, iritis, vitritis, neuroretinitis, panuveitis, retinitis appearing as small white intraretinal infiltrates, and choroidal white lesions [1, 2]. B. henselae is reported to be the most common cause of neuroretinitis; typically characterized by optic disk edema in association with a partial or complete macular star. The majority of infected patients presenting with neuroretinitis reported in the literature are treated with antibiotics. In some cases steroids were added. However several reports showed that even patients who did not receive treatment had an excellent visual outcome [1]. We describe here a paradoxical response to treatment in a young female presenting with bilateral neuroretinitis and inflammatory optic disk lesions.