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Atypical presentation of cat scratch disease: Parinaud’s oculoglandular syndrome with facial nerve paresis
  1. Cristhian Valor,
  2. Katherine Huber
  1. Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Cristhian Valor, cristhianvalor{at}


A 28-year-old man presented to our clinic over the course of 3 weeks with symptoms that progressed from mild headaches to fever, fatigue, myalgia and an enlarged right preauricular lymph node with ipsilateral conjunctivitis and upper eyelid weakness. Our differential included Epstein Barr Virus/Cytomegalovirus mononucleosis, bacterial conjunctivitis and lymphoma. We evaluated with CBC, EBV IgM Ab, lactate dehydrogenase level and a CMV IgG Ab which were all within normal limits. During his third visit, we discovered our patient had been scratched by two stray kittens he had adopted 2 months prior. We confirmed the diagnosis with a positive Bartonella henselae IgG level and diagnosed him with cat scratch disease presenting as Parinaud’s oculoglandular syndrome. He was treated with a 5-day course of Azithromycin 250 mg with definitive improvement.

  • infectious diseases
  • cranial nerves
  • radiology
  • general practice / family medicine
  • malignant and benign haematology

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  • Contributors CV, medical student in the third year, saw the patient in the diagnostic visit, included the disease to the differential and arrived at the diagnosis. He acquired patient consent to disclose PHI and wrote the case report manuscript. KH was the attending physician supervising CV. She added final remarks to the Case Report Manuscript and helped CV navigate the process of publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.