Bartonella henselae-Associated Optic Neuropathy Presenting as a Central Scotoma in the Absence of Overt Papillitis - A Multimodal Imaging Study

To describe the use of multimodal imaging to establish the diagnosis of Bartonella henselae-associated optic neuropathy in a patient who presented with a central scotoma without overt evidence of optic nerve involvement.Case report. Main outcome measures included clinical, optical coherence tomography, and fluorescein angiography findings.A 72-year-old woman presented with a three-day history of central scotoma in the left eye. Her examination was remarkable for faint exudation in the nasal macula of the left eye, but was otherwise normal for her age. Spectral domain optical coherence tomography of the macula revealed mild thickening of the papillomacular bundle with scattered small cystoid spaces and several intraretinal exudates, none of which were visible clinically. Fluorescein angiography revealed localized leakage of the inferotemporal optic disc. When prompted, the patient recalled being scratched multiple times by her two pet kittens. Serial testing showed rising anti-Bartonella henselae (B. henselae) IgG antibody titers to 1:1280, confirming the suspected diagnosis of B. henselae-associated optic neuropathy.and importance: Bartonella-associated optic nerve involvement can occur without overt evidence of optic disc swelling. Multimodal imaging can be used to suggest the diagnosis and support appropriate serologic testing.