Parinaud Oculoglandular Syndrome Among Female Adults in Malaysia: A Case Series

TL;DR

This case series reports three instances of Parinaud oculoglandular syndrome in Malaysian women linked to cat scratch disease, emphasizing the need for better diagnostic methods.

Contribution

The study presents real-world cases of POGS in Malaysia, highlighting diagnostic challenges and management strategies for atypical CSD presentations.

Findings

Three female cases of POGS were successfully managed with antibiotics and non-pharmacological interventions.

Clinical suspicion and history of feline contact are crucial for diagnosing atypical CSD cases.

PCR DNA testing for Bartonella henselae remains the gold standard but is often unavailable in some regions.

Abstract

Parinaud oculoglandular syndrome (POGS), is typically rare and often presented as a unilateral ocular inflammation accompanied by ipsilateral lymphadenopathy. POGS is an atypical manifestation of cat scratch disease (CSD) caused by Bartonella henselae (BH). Diagnosis of POGS poses a challenge due to its rarity and the array of potential etiologies including infections from fleas, ticks, and various microorganisms. This case series details three cases of CSD attributed to POGS, highlighting the diagnostic challenges faced in the absence of the gold standard diagnostic method, which is the polymerase chain reaction (PCR) DNA test for BH. The cases encompass a set of presentations including granulomatous inflammation and lymphadenopathy, managed effectively with antibiotics and non-pharmacological interventions such as flea control in domestic felines and hygiene measures post-feline inflicted injury. These cases highlight the necessity for heightened clinical suspicion, especially in patients with a history of feline contact, and appeal for further research to refine diagnostic criteria for more accurate and practical detection of CSD particularly for the atypical manifestations. This will be especially beneficial in areas where the more invasive lesion biopsy or gold standard PCR DNA test for BH are not available so accurate management can be instituted immediately in cases where there is multisystemic involvement.

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