Diagnosis:
Diagnosis of CSD can be challenging as Bartonella henselae is a fastidious organism and is difficult to culture. History of recent close contact with unvaccinated cats leads the diagnosis. Our patient had confirmed recent close contact with cats during a period of inebriation. Diagnosis of CSD is confirmed by serology testing looking for IgG and IgM antibodies against Bartonella henselae. Serology testing options include Immunofluorescence Assay (IFA) and Enzyme Immunoassay (EIA). Polymerase Chain Reaction (PCR) testing will also oftentimes be performed in addition to serology testing.
Other infectious disease testing included toxoplasmosis, rubella, cytomegalovirus, and herpes. These results all came back negative. Considering the patient presented with bilateral edematous optic nerves, he was also sent for MRI and lumbar puncture.
Presence of bilateral blurry vision, pain and photophobia had initially prompted the patient to consult with his eyecare provider. Oddly enough, the patient did not manifest any systemic symptoms throughout the course of the disease process. Systemic symptoms typically precede ocular findings in CSD.