1	Case Presentation Stephen Merriam, MD Edward S. Harkness Eye Institute
2	Patient History 5 y/o Hispanic boy was sent to the Eye Clinic by Pediatric ER for evaluation of right-sided periocular swelling for three days.
3	Past Medical History The child had no significant past medical or past ocular history, took no medications, had no known allergies to medications, and no significant family ocular history. This was his first ophthalmic evaluation
4	Clinical Exam V: 20/25 OD and 20/30 with Allen single letters Pupils: ERR, no APD External Exam: There was a large, tender, right preauricular lymph node Also a large, tender submandibular node on the right
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6	Slit Lamp Examination L/L: mild upper and lower lid edema OD C/S: there was an extensive bulbar follicular reaction nasally OD, adjacent to the caruncle with injection. A lesser similar reaction on the palpebral conjunctiva was also noted
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8	Slit Lamp Exam-cont’ K: Clear OU AC: Deep & quiet OU I/L: Normal OU
9	Dilated Fundus Examination D/M/V/P Within normal limit OU
10	Differential Diagnosis Oculoglandular conjunctivitis Bacterial adenitis secondary to Staph. aureus or Group A Beta hemolytic Streptococcus, atypical mycobacteria sp, Mycobacteria tuberculosis, Chlamydia and Tularemia
11	Impression The child had recently been to the Dominican Republic, where he visited his grandmother who had cats at home as pets Working diagnosis: Oculoglandular Conjunctivitis
12	Management Plan Systemic antibiotics: Azythromycin 250 mg QD (after a 500 mg loading dose) for 1 week Patient was instructed to return in four days for follow-up, but failure to keep the scheduled return visit
13	Discussion Oculoglandular conjunctivitis (Parinaud’s oculoglandular syndrome; cat-scratch disease) is typically: Unilateral Associated with an ipsilateral adenopathy Caused by Bartonella henselae or B. quintana Systemic symptoms may include mild fever, malaise, and headache Less commonly, splenomegaly, anorexia and weight loss may be seen
14	Discussion-cont’ Usually self-limited and resolves spontaneously over 2 – 4 months It can affect multiple organ systems, causing erythema nodosum and erythema multiforme, as well as arthritis and osteomyelitis Neurologic involvement is signaled by encephalopathy and may be accompanied by seizures Some clinicians feel that antibiotics are not useful, while others advocate antibiotic use Prognosis is usually excellent