Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 27 peer-reviewed journal articles Updated
Infectious Disease

Atypical Presentations & Complications

At a Glance

While most cat-scratch disease (CSD) causes only swollen lymph nodes, up to 20% of cases spread to other parts of the body. Atypical CSD can cause eye infections, liver and spleen involvement leading to prolonged fevers, or rarely, brain inflammation. Most patients recover fully with treatment.

While most cases of Cat-scratch disease (CSD) follow a predictable path of swollen lymph nodes and mild fever, approximately 5% to 20% of patients develop “atypical” or “disseminated” forms of the infection [1][2]. This happens when the bacteria spread beyond the local lymph nodes and affect other organs.

Ocular (Eye) Involvement

The eyes are one of the most common sites for atypical CSD, occurring in about 5% to 10% of cases [3][4].

  • Parinaud Oculoglandular Syndrome (POGS): This presents as an eye infection that looks like severe pink eye, usually in only one eye, accompanied by a swollen lymph node just in front of the ear [5][6]. It is generally less severe than other complications and often resolves smoothly [5].
  • Neuroretinitis (Rare, 1-2%): A more serious condition involving inflammation of the optic nerve and the retina [7]. It often causes sudden, painless vision loss in one eye [8]. On an eye exam, doctors may see a characteristic “macular star”—a star-shaped pattern in the back of the eye [7][9].

Visceral (Organ) Involvement

In some patients, the infection can spread to the internal organs [10].

  • Hepatosplenic CSD: The bacteria can travel to the liver and spleen, causing small nodules to form [11][12]. This often presents as a prolonged fever and sometimes abdominal pain [13][14].
  • Bone Involvement (Osteomyelitis): Very rare (less than 1%), CSD can cause inflammation in the bones, most often the spine or pelvis, presenting as localized pain [15][16].

Neurological Complications

In fewer than 1% of cases, CSD can affect the central nervous system, leading to encephalopathy (brain inflammation) [17].

  • Symptoms: High fever, severe headache, confusion, or seizures [18][19].
  • Prognosis: While scary, the vast majority of patients with Bartonella-related brain involvement recover completely with proper medical care [20][21].

The Impact of the Immune System

How CSD presents depends heavily on the patient’s immune system health.

  • Immunocompetent Patients: In healthy individuals, the immune system usually keeps the infection “contained,” leading to the typical swollen lymph nodes [22][23].
  • Immunocompromised Patients: In people with weakened immune systems (such as those with HIV or organ transplants), the body cannot contain the bacteria [23]. This can lead to bacillary angiomatosis, where the bacteria cause new blood vessels to grow abnormally, creating reddish-purple skin bumps [23][24]. It can also lead to peliosis hepatis, where blood-filled cysts form in the liver [25][23].

Because these presentations are complex, they often require a combination of specialized imaging and molecular testing to guide a more intensive treatment plan [26][27].

Common questions in this guide

Can cat-scratch disease affect my eyes?
Yes, in about 5% to 10% of cases, the bacteria can affect the eyes. This may cause an infection resembling severe pink eye with a swollen lymph node near the ear, or rarely, a more serious condition causing sudden vision loss.
What are the signs that a cat scratch infection has spread to internal organs?
If the infection spreads to the liver or spleen, it often causes a prolonged fever lasting more than a week and sometimes abdominal pain. Your doctor may order an abdominal ultrasound or CT scan to check for these internal complications.
Is it normal to have a prolonged fever with cat-scratch disease?
While a mild, short-term fever is typical, a prolonged fever can be a warning sign that the infection has spread to the liver or spleen. You should consult your doctor if a fever persists for more than a week.
Why are cat-scratch disease symptoms worse for immunocompromised patients?
Patients with weakened immune systems, such as those with HIV or organ transplants, have trouble keeping the bacteria contained in the lymph nodes. This can lead to severe issues like abnormal blood vessel growth resulting in reddish-purple skin bumps.
Does cat-scratch disease cause brain inflammation?
In very rare cases (fewer than 1%), the infection can spread to the central nervous system and cause brain inflammation. Symptoms include high fever, severe headaches, confusion, or seizures, but most patients recover completely with proper medical care.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on the atypical symptoms we're seeing, do we need to consult a specialist like an ophthalmologist or a neurologist?
  2. 2.If we suspect hepatosplenic involvement, is an abdominal ultrasound the best first step, or should we consider a more detailed CT scan?
  3. 3.What are the signs that the infection is becoming systemic rather than just staying in the lymph nodes?
  4. 4.For immunocompromised patients, how does the treatment plan differ from the standard approach for CSD?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (27)
  1. 1

    Atypical Manifestations of Cat-Scratch Disease, United States, 2005-2014.

    Nawrocki CC, Max RJ, Marzec NS, Nelson CA

    Emerging infectious diseases 2020; (26(7)):1438-1446 doi:10.3201/eid2607.200034.

    PMID: 32568056
  2. 2

    A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child.

    Sodini C, Zani EM, Pecora F, et al.

    Microorganisms 2021; (9(5)) doi:10.3390/microorganisms9050950.

    PMID: 33924906
  3. 3

    Posterior Segment Manifestations of Cat-scratch Disease: A Mini-review of the Clinical and Multi-modal Imaging Features.

    Karti O, Ataş F, Saatci AO

    Neuro-ophthalmology (Aeolus Press) 2021; (45(6)):361-371 doi:10.1080/01658107.2021.1939393.

    PMID: 34720266
  4. 4

    [Visual impairment related to an isolated paracentral cotton wool spot revealing an atypical presentation of Bartonella henselae retinitis].

    Vantomme M, Sambon P, Laruelle G, et al.

    Revue medicale de Liege 2025; (80(7-8)):539-544.

    PMID: 40762344
  5. 5

    Francisella tularensis Infection Causing Parinaud Oculoglandular Syndrome.

    Nagy KI, Pribelszki E, Sira Á, et al.

    The American journal of case reports 2024; (25()):e943915 doi:10.12659/AJCR.943915.

    PMID: 38941282
  6. 6

    Cat-scratch Disease with Parinaud's Oculoglandular Syndrome.

    Menezes AS, Ribeiro D, Lima AF

    Turkish archives of otorhinolaryngology 2020; (58(1)):48-51 doi:10.5152/tao.2020.4792.

    PMID: 32313895
  7. 7

    A challenging differential diagnosis of optic neuropathy in ED: CSD.

    Ak R, Doganay F, Akoglu EU, Ozturk TC

    BMJ case reports 2015; (2015()).

    PMID: 26077806
  8. 8

    A Case Series of Cat-Scratch Disease with Ocular Manifestations: Clinical Findings and Treatment Approach.

    Acar A, Çakar Özdal P, Başarır B, et al.

    Turkish journal of ophthalmology 2023; (53(4)):226-233 doi:10.4274/tjo.galenos.2022.44692.

    PMID: 37602640
  9. 9

    Not cat-scratch disease: Bartonella henselae neuroretinitis associated with non-feline pet mammals.

    Orellana-Rios J, Verdaguer-Diaz JI, Opazo G, et al.

    IDCases 2020; (22()):e00978 doi:10.1016/j.idcr.2020.e00978.

    PMID: 33083230
  10. 10

    Cat Scratch Disease: 9 Years of Experience at a Pediatric Center.

    Amin O, Rostad CA, Gonzalez M, et al.

    Open forum infectious diseases 2022; (9(9)):ofac426 doi:10.1093/ofid/ofac426.

    PMID: 36072697
  11. 11

    Suspected Hepatosplenic Cat Scratch Disease with No Major Symptoms and Negative Serology: A Case Report.

    Osawa H, Shibutani K, Mori N

    The American journal of case reports 2025; (26()):e949495 doi:10.12659/AJCR.949495.

    PMID: 41160532
  12. 12

    Splenorenal Manifestations of Bartonella henselae Infection in a Pediatric Patient.

    Rising T, Fulton N, Vasavada P

    Case reports in radiology 2016; (2016()):7803832 doi:10.1155/2016/7803832.

    PMID: 27127672
  13. 13

    Bartonella henselae tricuspid valve endocarditis presenting as fever of unknown origin.

    Wohlgenant Z, Hansen M, McDonough M, Cutshaw M

    BMJ case reports 2026; (19(2)) doi:10.1136/bcr-2025-268764.

    PMID: 41638765
  14. 14

    Hepatosplenic Cat Scratch Disease and Prolonged Fever: When To Add Corticosteroids?

    Pérez Pérez A, Fernández Miaja M, Díaz García P, et al.

    The Pediatric infectious disease journal 2022; (41(9)):e396-e398 doi:10.1097/INF.0000000000003591.

    PMID: 35622421
  15. 15

    Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma-A Case Report and Literature Review.

    Donà D, Nai Fovino L, Mozzo E, et al.

    Case reports in pediatrics 2018; (2018()):1679306 doi:10.1155/2018/1679306.

    PMID: 29808150
  16. 16

    Torticollis and Fever in a Young Boy: A Unique Presentation of Cat-Scratch Disease With Vertebral Osteomyelitis and Epidural Phlegmon.

    Rafferty JR, Janopaul-Naylor E, Riese J

    Pediatric emergency care 2017; (33(12)):e164-e166 doi:10.1097/PEC.0000000000001330.

    PMID: 29095386
  17. 17

    Bartonella-Associated Transverse Myelitis.

    Sendi P, Hirzel C, Bloch A, et al.

    Emerging infectious diseases 2017; (23(4)):712-713 doi:10.3201/eid2304.161733.

    PMID: 28322716
  18. 18

    Cat Scratch Disease-associated Encephalitis Followed by Parkinsonism.

    Nakamura M, Ura S, Yabe I, et al.

    Internal medicine (Tokyo, Japan) 2022; (61(20)):3115-3120 doi:10.2169/internalmedicine.9047-21.

    PMID: 35314550
  19. 19

    A Rare Case of Bartonella Encephalitis With Hemiplegia.

    Rosas L, Rao K, McGough C, Becker A

    Child neurology open 2019; (6()):2329048X19826480 doi:10.1177/2329048X19826480.

    PMID: 30746387
  20. 20

    [Bartonella henselae with atypical infection and neuroretinitis in a pediatric unit: report of three cases].

    Pérez R, Fischman A, Poblete MJ, et al.

    Revista chilena de infectologia : organo oficial de la Sociedad Chilena de Infectologia 2020; (37(4)):463-469 doi:10.4067/S0716-10182020000400463.

    PMID: 33399668
  21. 21

    Encephalopathy in an adult with cat-scratch disease.

    Samarkos M, Antoniadou V, Vaiopoulos AG, Psichogiou M

    BMJ case reports 2018; (2018()) doi:10.1136/bcr-2017-223647.

    PMID: 29507029
  22. 22

    Can Lymphadenopathy Guide the Diagnosis of Hepatosplenic Bartonella Infection in Pediatric Renal Transplant Recipients? What Is the Optimal Treatment and Follow-Up Duration?

    Alataş ŞÖ, Erbaş İC, Güzin AÇ, et al.

    Pediatric transplantation 2025; (29(5)):e70113 doi:10.1111/petr.70113.

    PMID: 40495288
  23. 23

    Bartonella infections diagnosed in the French reference center, 2014-2019, and focus on infections in the immunocompromised.

    Luciani L, El Baroudi Y, Prudent E, et al.

    European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2021; (40(11)):2407-2410 doi:10.1007/s10096-021-04244-z.

    PMID: 33846874
  24. 24

    Cat-Scratch Disease in an AIDS Patient Presenting with Generalized Lymphadenopathy: An Unusual Presentation with Delayed Diagnosis.

    Mantis J, Ali Y, Junejo SZ

    The American journal of case reports 2018; (19()):906-911 doi:10.12659/AJCR.909325.

    PMID: 30068900
  25. 25

    Hemorrhage and Rupture of an Unusual Benign Liver Lesion in Pregnancy: A Case Report.

    Agarwal A, Joy D, Das P, et al.

    Journal of clinical and experimental hepatology 2021; (11(2)):260-263 doi:10.1016/j.jceh.2020.07.004.

    PMID: 33746452
  26. 26

    Kawasaki Disease or Cat Scratch Disease? A Diagnostic Dilemma: A Paediatric Case Report and Literature Review.

    Gorczyca D, Lewandowski D, Postępski J

    Mediterranean journal of rheumatology 2025; (36(2)):322-328 doi:10.31138/mjr.100624.ahe.

    PMID: 40757139
  27. 27

    Typical and Atypical 18FDG PET/CT Findings in Two Cases of Cat Scratch Disease.

    Zhou W, Gong L, Zuo C, Zhang J

    Clinical nuclear medicine 2019; (44(6)):e388-e391 doi:10.1097/RLU.0000000000002558.

    PMID: 30985438

This page discusses rare complications of cat-scratch disease for educational purposes only. Always consult your doctor if you or your child experience persistent fevers, vision changes, or severe neurological symptoms.

Get notified when new evidence is published on Cat-scratch disease.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.