Cat Scratch Scleritis

This quartet of images comes from a 54 year old woman who kept feral cats and recalled a scratch followed by a febrile illness 2 months before presenting with horizontal diplopia and left brow pain. She had a posterior nodular scleritis of the left eye with an overlying retinitis (panel A). The fluorescein angiogram showed staining of the lesion (panel B). The OCT showed a nodular swelling of the sclera (panel C) with overlying outer nuclear layer hyper reflectivity. The Bartonella Hensellae IgG titer was > 1:1,250. After three weeks of ciprofloxacin 750 mg bid her diplopia and pain had resolved and the lesion was regressing (panel D).