Treatment and Management:
Cat scratch disease does not typically require treatment as the symptoms are usually self-limited in nature. Treatment with antipyretics and warm compresses at the site of inoculation are usually sufficient for mild cases. Severe systemic findings/ocular findings warrant treatment with systemic antibiotics, as well as both topical and systemic corticosteroids.
The patient was started on a course of systemic antibiotics, systemic steroids and topical steroids upon initial diagnosis. Systemic treatment led to recession of the neuroretinitis. However, his previous provider tapered the topical steroids too rapidly. This resulted in a rebound anterior uveitis. We started the patient on prednisolone acetate 1% every 2 hours while awake as well as cyclopentolate 1% twice a day. Follow-up visits over the course of the month demonstrated a marked reduction in ocular inflammation and a substantial improvement in patient comfort.
The patient mentioned that he would be returning to his home country at the end of the month. We strongly encouraged the patient to establish care with an eyecare provider upon his arrival and emphasized the importance of a slow taper with the topical steroid.