Isolated Conjonctival Granuloma Revealing Bartonella Henselae Infection

To report the clinical presentation and management of a case of a 10-year old child with Parinaud's oculoglandular syndrome presenting as an isolated unilateral conjunctival granuloma.

Conjunctival granuloma has a wide range of differential diagnoses, including local causes and systemic diseases. One relevant cause is ocular bartonellosis and its primary manifestation.

Parinaud’s oculoglandular syndrome (POGS) is a form of unilateral and non suppurative conjunctivitis, with an area of focal granulomatous reaction. It is associated with regional lymphadenopathy that predominantly affects either the preauricular or submandibular lymph nodes.

Department of Ophthalmology, Ibn Sina Hospital, Rabat, Morocco.

A 10-year-old child presented with complaints of a 1-week history of non-traumatic unilateral red eye and chemosis, with no pain or any other symptoms. Slit lamp examination revealed an isolated bulbar conjunctival granuloma. The remainder of the eye examination and the left eye exam were unremarkables. 

One week after the first symptoms appeared, the patient developed fever, and preauricular ipsilateral adenopathie.

 A conjunctival biopsy was done the following day and etiological work-up was performed.

Conjunctival drops (tobramycin and dexamethasone ) were administered every 4 hours. The serological confirmation of acute Bartonella henselae infection allows us to establish the diagnosis of Parinaud's oculoglandular syndrome.

Oral azithromycin was added to the topical treatment. The evolution was satisfactory, with remission of fever, disappearance of conjunctival granuloma and progressive decrease of lymphadenopathy.

 

Ocular bartonellosis should be suspected in patients presenting with unilateral conjunctival granuloma that persists despite topical medication(s), especially if regional adenopathies are pesent, and there is a history of cat contact.