Parinaud's oculoglandular syndrome

Overview

Parinaud's oculoglandular syndrome is a rare, localized manifestation of systemic infection, primarily affecting the eyes and nearby lymph nodes. It presents as a unilateral granulomatous conjunctivitis (inflammation of the conjunctiva) accompanied by regional lymphadenopathy, typically involving the preauricular or submandibular lymph nodes. Named after French ophthalmologist Henri Parinaud, this syndrome is most commonly associated with cat scratch disease caused by the bacterium Bartonella henselae, but can also be triggered by other infectious agents. The condition primarily affects children and young adults and is usually self-limiting, though treatment may be required to alleviate symptoms and manage complications.

Causes

Parinaud's oculoglandular syndrome is most often caused by infectious agents, with cat scratch disease being the leading etiology. In this condition, the bacteria enter the body through a scratch or bite from a cat and then spread to the conjunctiva and regional lymph nodes. Other causes include:

• Tularemia – caused by Francisella tularensis

• Sporotrichosis – a fungal infection caused by Sporothrix schenckii

• Tuberculosis – Mycobacterium tuberculosis can rarely cause ocular involvement

• Syphilis – Treponema pallidum infection may affect the eyes in rare cases

• Herpes simplex virus (HSV) or Epstein–Barr virus (EBV)

• Other bacterial conjunctivitis – such as Staphylococcus aureus or Chlamydia trachomatis

Direct inoculation of the conjunctiva or spread through blood or lymphatic pathways leads to the characteristic ocular and lymph node symptoms.

Symptoms

Parinaud's oculoglandular syndrome typically affects one eye and has a sudden onset. The most common clinical features include:

Ocular Symptoms

• Unilateral conjunctivitis: Redness, swelling, and irritation of one eye

• Granulomatous lesions: Nodular or raised lesions on the conjunctiva, often with mucopurulent discharge

• Photophobia: Sensitivity to light

• Tearing and foreign body sensation

• Conjunctival hemorrhage or ulceration in severe cases

Systemic and Regional Symptoms

• Preauricular or submandibular lymphadenopathy: Swollen, tender lymph nodes near the affected eye

• Fever: Low-grade in most cases, more pronounced with systemic infection

• Malaise and fatigue

• Skin lesions: If caused by cat scratch disease, a papule or pustule may be seen at the scratch site

Diagnosis

Diagnosis of Parinaud’s oculoglandular syndrome is based on clinical findings, exposure history, and laboratory confirmation. The following diagnostic steps are typically undertaken:

• Clinical history: Inquire about recent exposure to cats, scratches, bites, or other zoonotic risk factors

• Ophthalmic examination: Slit-lamp exam to assess conjunctival lesions and exclude other causes of unilateral conjunctivitis

• Lymph node examination: Palpation of preauricular and submandibular areas to detect enlarged nodes

• Serologic tests: Antibody tests for Bartonella henselae, Francisella tularensis, and other relevant pathogens

• Polymerase Chain Reaction (PCR): Useful for confirming Bartonella or other infections from blood or conjunctival swabs

• Cultures: May be taken from conjunctival discharge or lymph nodes if abscessed

• Biopsy: Rarely needed, but may help rule out malignancies or other granulomatous diseases

Treatment

Treatment of Parinaud’s oculoglandular syndrome depends on the underlying cause. Mild cases may resolve spontaneously, particularly in cat scratch disease, but antibiotic therapy is often used to speed recovery and prevent complications.

1. Antimicrobial Therapy

• Cat scratch disease: Azithromycin is commonly used; doxycycline or rifampin may be considered in severe or resistant cases

• Tularemia: Treated with streptomycin or gentamicin

• Sporotrichosis: Itraconazole or other antifungals

• Tuberculosis: Requires multidrug anti-tubercular therapy

2. Symptomatic Management

• Warm compresses: Help relieve lymph node swelling and discomfort

• Lubricating eye drops: To soothe conjunctival irritation

• Analgesics and antipyretics: For fever and pain relief

3. Surgical Intervention

• Incision and drainage may be required for suppurative lymphadenopathy

Prognosis

The prognosis for Parinaud’s oculoglandular syndrome is generally excellent, especially with appropriate antimicrobial treatment. Most patients recover fully within 2–6 weeks. However, complications can occur if left untreated, including:

• Persistent lymphadenopathy or suppuration

• Chronic conjunctivitis or scarring

• Rarely, systemic spread of the infection

Early recognition and proper management are key to avoiding complications and ensuring complete recovery. Recurrence is uncommon but can occur if the initial infection is not fully treated or if re-exposure to the causative pathogen happens.