# Optic Neuritis and Vertebral Osteomyelitis: An Uncommon Presentation of Cat-Scratch Disease

## TL;DR

A woman with cat-scratch disease showed rare symptoms of optic neuritis and vertebral osteomyelitis, highlighting the disease's unusual presentation.

## Contribution

This case report documents a rare combination of atypical manifestations of cat-scratch disease in a single patient.

## Key findings

- The patient exhibited optic neuritis confirmed by elevated Bartonella IgG.
- Vertebral osteomyelitis was diagnosed via MRI and linked to cat-scratch disease.
- Treatment with antibiotics and corticosteroids led to clinical improvement.

## Abstract

In cat-scratch disease (CSD), hematogenous spread may result in atypical presentations. Ocular manifestations develop in a minority of patients, with treatment being important in reducing long-term visual sequelae. Bone infection is rare. We present the case of a 52-year-old woman, with close contact with cats, reporting acute unilateral blurred vision and presenting papilledema, optic disc pallor, and peripapillary hemorrhage. Etiologic study of optic neuritis revealed an elevated positive Bartonella IgG; hence, treatment for CSD with doxycycline plus rifampin and corticosteroids was started. Concomitant lumbar pain of increasing intensity warranted magnetic resonance imaging, which revealed L3-L4 vertebral osteomyelitis with spondylodiscitis. Given the temporal link with CSD diagnosis and the significant clinical improvement since its treatment was started, an etiologic link was presumed and antibiotics were prolonged. This case stands out for the presence of distinct atypical CSD manifestations in the same patient. Further studies are needed to determine the optimal treatment for rare manifestations, particularly bone infection.