Journal Article

Cranial nerve neuropathies: a rare manifestation of cat scratch disease

Yakubovsky, Michal, Kadar, Laliv, Zimhony, Oren, Kosman, Alex, Yahav, Dafna, Giladi, Michael, Gadoth, Avi, Grisaru-Soen, Galia, Ephros, Moshe, Paran, Yael, Ben-Ami, Ronen, Strahilevitz, Jacob

2026

Overview

Background Cranial nerve neuropathies represent a rare manifestation of cat scratch disease (CSD). Only a few case reports have been published, and the full clinical spectrum remains poorly characterized. We aimed to describe the clinical presentation, diagnostic approach, and prognosis of cat scratch disease (CSD)-associated cranial nerve neuropathies, a manifestation that is poorly characterized. Methods Using data from a national CSD surveillance study, we identified patients with CSD-associated cranial neuropathies confirmed by serology and/or PCR for Bartonella henselae. Clinical, epidemiological, and imaging data were analyzed. Follow-up was conducted. Results Seven immunocompetent patients with cranial nerve neuropathies were identified among approximately 4100 CSD patients diagnosed over a 28-year period (1997–2025). Affected cranial nerves included the facial ( n  = 3), abducens ( n  = 2), oculomotor ( n  = 1), and glossopharyngeal ( n  = 1) nerves, the latter two not previously reported in patients with CSD. All patients reported cat exposure. Neuropathies were accompanied by other CSD-related features, including fever (71%), lymphadenitis (57%), neuroretinitis (43%), and encephalitis (14%). Three patients received antibiotic therapy and five were treated with systemic corticosteroids. Six patients fully recovered within a median of 4 weeks; one patient showed marked improvement after 3 months and was subsequently lost to follow-up. Conclusion CSD-associated cranial neuropathies are rare and possibly underdiagnosed. Diagnostic clues include cat contact and concurrent CSD features such as fever, lymphadenopathy, or neuroretinitis. These findings are hardly observed in idiopathic cranial nerve palsies such as Bell’s palsy, for which guidelines recommend against routine serologic evaluation. Although outcomes are generally favorable, optimal treatment remains undefined. We suggest testing for B. henselae infection in patients with cranial neuropathies when CSD is suspected. Increased clinical awareness is warranted to facilitate timely diagnosis and management.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Bartonella henselae / Bell’s palsy / Case reports / Cat scratch disease / Corticoids / Corticosteroids / Cranial nerve palsy / Cranial nerves / Diplopia / Encephalitis / Enzymes / Epidemiology / Fever / HIV / Human immunodeficiency virus / Infections / Infectious Diseases / Internal Medicine / Lymphadenitis / Lymphadenopathy / Lymphatic system / Medical imaging / Medical Microbiology / Medicine / Medicine & Public Health / Nerves / Neuroimaging / Neurological disorders / Neuropathy / Parasitology / Patients / Retinitis / Serology / Skull / Surveillance / Tropical Medicine