Parinaud Oculoglandular Syndrome Without Feline Trauma In A Young Boy

To describe a paediatric case of Parinaud oculoglandular syndrome presenting as a conjunctival mass with chemosis and lymphadenopathy, highlighting diagnostic challenges and successful medical management.

Whipps Cross Hospital, a district general hospital in London, United Kingdom.

A 7‑year‑old boy presented with a 2 week history of unilateral foreign body sensation unresponsive to topical chloramphenicol and sodium cromoglycate. Clinical examination revealed marked temporal chemosis, a large inferior conjunctival mass with intralesional granulomas, and ipsilateral preauricular lymphadenopathy in an otherwise systemically well child. Detailed history, including exposure to two household cats with no recalled trauma, was obtained. A clinical diagnosis of Parinaud oculoglandular syndrome was made, and the patient was treated with oral azithromycin while awaiting Bartonella serology.

The child showed progressive improvement in symptoms and signs following initiation of azithromycin, with complete clinical resolution of the conjunctival mass and chemosis within 3 weeks. Lymphadenopathy also improved. Bartonella serology was positive, confirming the causative agent.

Parinaud oculoglandular syndrome should be considered in children presenting with unilateral granulomatous conjunctivitis and preauricular lymphadenopathy, even in the absence of a clear history of cat scratch or bite. Careful history, recognition of the characteristic ocular signs and targeted serological testing allow prompt diagnosis and treatment, and macrolide therapy such as azithromycin can lead to rapid and complete resolution in cases where doxycycline is contraindicated.