Double Trouble: Parinaud Oculoglandular Syndrome From Sporotrichosis And Follicular Conjunctivitis From Moraxella Osloensis, A Zoonotic Co-Infection From Our Feline Friend - A First In Thailand

To report a very rare case of Parinaud Oculoglandular Syndrome (POGS) from ocular sporothrichosis (Sporothrix schenckii) and co-infection of Moraxella osloensis, characterised by follicular conjunctivitis, both of which share the same vector in zoonotic transmission. To demonstrate a clinical approach to granulomatous conjunctivitis. To illustrate the use of microbiological procedures and special staining in aid of identification of the thermally dimorphic fungus Sporothrix schenckii, having both a yeast and mold form. To show pathological characteristics of necrotising granulomatous inflammation associated with POGS. To acknowledge the existence of Moraxella osloensis infection in cases of zoonotic follicular conjunctivitis.

Department of Ophthalmology, Faculty of Medicine, Thammasat University Hospital (TUH), Pathum Thani Province, Thailand

This case report is a retrospective review of medical records in November 2023 and December 2023. Reviews of microbiological specimens and special stainings were done at the Microbiology Laboratory, TUH. Pathological specimens were reviewed with the attending pathologist at the Pathology Department, TUH. Photographs of microbiological and pathological specimens were taken with permission. A photograph of the sick cat was taken from the patient’s mobile phone with consent.

A 41-year-old woman presented with chronic unilateral granulomatous conjunctivitis and ipsilateral regional lymphadenopathy. A diagnosis of Parinaud oculoglandular syndrome (POGS) was made. The patient reported close contact with a sick pet cat. Fungal cultures from tear swabs demonstrated evidence of Sporothrix, which later confirmed the isolate to be Sporothrix schenckii by 18S ribosomal RNA Polymerase Chain Reaction testing. Bacterial cultures also identified Moraxella osloensis. Biopsy of granulomatous lesions showed suppurative necrotising granulomatous inflammation. Antimicrobial therapy with oral itraconazole 200 mg twice daily, topical amphotericin B and amikacin eye drops were initiated, subsequently resulted in remission of POGS.

Despite cat-scratch disease (CSD) caused by Bartonella henselae being the most common cause of POGS, Sporothrix schenckii should always be considered in the differential in those presenting with POGS especially in those with history of contact with sick ulcerated cats. As cats are generally vectors of numerous zoonotic agents, co-infection with other bacterial species such as Moraxella osloensis should not be ignored in those presenting with signs of follicular bacterial conjunctivitis. Technological advances in special staining and 18S ribosomal PCR assays are useful in aid of fungal species identification.