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Background <p>Cranial nerve neuropathies represent a rare manifestation of cat scratch disease (CSD). Only a few case reports have been published, and the full clinical spectrum remains poorly characterized. We aimed to describe the clinical presentation, diagnostic approach, and prognosis of cat scratch disease (CSD)-associated cranial nerve neuropathies, a manifestation that is poorly characterized.</p> Methods <p>Using data from a national CSD surveillance study, we identified patients with CSD-associated cranial neuropathies confirmed by serology and/or PCR for Bartonella henselae. Clinical, epidemiological, and imaging data were analyzed. Follow-up was conducted.</p> Results <p>Seven immunocompetent patients with cranial nerve neuropathies were identified among approximately 4100 CSD patients diagnosed over a 28-year period (1997–2025). Affected cranial nerves included the facial (<i>n</i> = 3), abducens (<i>n</i> = 2), oculomotor (<i>n</i> = 1), and glossopharyngeal (<i>n</i> = 1) nerves, the latter two not previously reported in patients with CSD. All patients reported cat exposure. Neuropathies were accompanied by other CSD-related features, including fever (71%), lymphadenitis (57%), neuroretinitis (43%), and encephalitis (14%). Three patients received antibiotic therapy and five were treated with systemic corticosteroids. Six patients fully recovered within a median of 4 weeks; one patient showed marked improvement after 3 months and was subsequently lost to follow-up.</p> Conclusion <p>CSD-associated cranial neuropathies are rare and possibly underdiagnosed. Diagnostic clues include cat contact and concurrent CSD features such as fever, lymphadenopathy, or neuroretinitis. These findings are hardly observed in idiopathic cranial nerve palsies such as Bell’s palsy, for which guidelines recommend against routine serologic evaluation. Although outcomes are generally favorable, optimal treatment remains undefined. We suggest testing for B. henselae infection in patients with cranial neuropathies when CSD is suspected. Increased clinical awareness is warranted to facilitate timely diagnosis and management.</p>

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Cranial nerve neuropathies: a rare manifestation of cat scratch disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月24日

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  • Michal Yakubovsky,
  • Alex Kosman,
  • Laliv Kadar,
  • Yael Paran,
  • Galia Grisaru-Soen,
  • Avi Gadoth,
  • Dafna Yahav,
  • Ronen Ben-Ami,
  • Jacob Strahilevitz,
  • Oren Zimhony,
  • Moshe Ephros,
  • Michael Giladi

摘要

Background

Cranial nerve neuropathies represent a rare manifestation of cat scratch disease (CSD). Only a few case reports have been published, and the full clinical spectrum remains poorly characterized. We aimed to describe the clinical presentation, diagnostic approach, and prognosis of cat scratch disease (CSD)-associated cranial nerve neuropathies, a manifestation that is poorly characterized.

Methods

Using data from a national CSD surveillance study, we identified patients with CSD-associated cranial neuropathies confirmed by serology and/or PCR for Bartonella henselae. Clinical, epidemiological, and imaging data were analyzed. Follow-up was conducted.

Results

Seven immunocompetent patients with cranial nerve neuropathies were identified among approximately 4100 CSD patients diagnosed over a 28-year period (1997–2025). Affected cranial nerves included the facial (n = 3), abducens (n = 2), oculomotor (n = 1), and glossopharyngeal (n = 1) nerves, the latter two not previously reported in patients with CSD. All patients reported cat exposure. Neuropathies were accompanied by other CSD-related features, including fever (71%), lymphadenitis (57%), neuroretinitis (43%), and encephalitis (14%). Three patients received antibiotic therapy and five were treated with systemic corticosteroids. Six patients fully recovered within a median of 4 weeks; one patient showed marked improvement after 3 months and was subsequently lost to follow-up.

Conclusion

CSD-associated cranial neuropathies are rare and possibly underdiagnosed. Diagnostic clues include cat contact and concurrent CSD features such as fever, lymphadenopathy, or neuroretinitis. These findings are hardly observed in idiopathic cranial nerve palsies such as Bell’s palsy, for which guidelines recommend against routine serologic evaluation. Although outcomes are generally favorable, optimal treatment remains undefined. We suggest testing for B. henselae infection in patients with cranial neuropathies when CSD is suspected. Increased clinical awareness is warranted to facilitate timely diagnosis and management.