Bartonella henselae bacilli detected in vitrectomy aspirates in a patient with massive vitreous opacity with total retinal detachment

Purpose: To present endophthalmitis-like massive vitreous opacity as a manifestation of cat-scratch disease. Methods: Report of a case. Results: A 47-year-old man developed massive vitreous opacity and total retinal detachment in his right eye after a four-month period of uveitis, which was controlled with oral prednisolone. During the diagnostic vitrectomy, a massive fluffy white opacity adhering to the detached retina was shaved using a vitreous cutter. Further surgical procedures to reattach the retina were not pursued because of the poor state of the infected retina. Pathological examination of the vitreous aspirates revealed pleomorphic bacilli. The serological testing done at referral revealed an IgG titer positive for Bartonella henselae and culture of the vitreous proved the infection a month later. With a mixture of oral sulfamethoxazole (1600 mg daily) and trimethoprim (320 mg daily), the intraocular inflammation subsided. Conclusion: Rapid progression of massive vitreous opacity with total retinal detachment, mimicking endophthalmitis, can occur in cat-scratch disease.