A case of optic neuropathy due to cat scratch disease (CSD) and syphilis co-infection with characteristic MRI findings (P2.137)
Bibliographic record
Abstract
Objective: To report a case of optic neuropathy caused by CSD and syphilis co-infection with characteristic MRI findings. Background: A 38-year-old healthy Caucasian woman presented with 2 months of new-onset headache and neck stiffness following a viral illness, followed by 1 month of blurred vision in her right eye. On examination, she had cervical lymphadenopathy, a right relative afferent pupillary defect and grade III right optic disc edema without evidence of a macular star. Visual acuity was 20/20 bilaterally with intact color vision. Design/Methods: She underwent MRI of the brain and orbits with contrast. A full infectious and autoimmune workup was performed to investigate the etiology of her unilateral optic neuropathy. Results: MRI of the orbits with contrast revealed avid enhancement of a 3-mm anterior segment of optic nerve at the right optic nerve-globe junction, a finding previously reported in a case series to be highly specific for CSD. Patient acknowledged that she has 3 cats at home by whom she was scratched regularly. Further workup revealed positive Bartonella serology (IgG 1:512). Interestingly she also had reactive syphilis serologies in serum (1:128) and CSF (1:8), consistent with neurosyphilis co-infection. She received 6 weeks of doxycycline and rifampin and 2 weeks of IV penicillin G for both CSD and neurosyphilis. At follow-up, she had complete resolution of optic disc edema, improved vision (20/12.5 OD) and resolution of the optic nerve enhancement on repeat MRI. Conclusions: This case demonstrated a rare case of optic neuropathy due to CSD and syphilis co-infection. The constellation of optic neuropathy, lymphadenopathy and characteristic optic nerve head enhancement on MRI is highly specific for optic neuropathy due to CSD. It is important for clinicians to identify optic neuropathies due to infectious etiologies as they often have favorable prognosis with treatment. Disclosure: Dr Gao has nothing to disclose. Dr. Chan has nothing to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".