Vague Presentation of Cat Scratch Disease in a Child

TL;DR

A child with a mysterious infection was diagnosed with cat scratch disease after a series of tests and surgery revealed Bartonella henselae.

Contribution

This case highlights the importance of considering Bartonella henselae in children with unexplained fever and soft tissue swelling.

Findings

The patient's symptoms progressed from a bug bite to suppurative adenitis and necrotizing granulomatous lymphadenitis.

PCR and antibody testing confirmed Bartonella henselae infection with a high IgG titer.

Treatment with azithromycin resolved the infection without complications.

Abstract

Background: Prolonged fever for more than a week or fever of unknown origin in pediatric patients with or without soft tissue infection should raise suspicion for Bartonella henselae infection.

Case Report: A 10-year-old female presented to urgent care with a “bug bite” on the left ring finger, cough, and 2 to 3 days of low-grade fever. Ten days later, her symptoms progressed to soft tissue swelling of the left elbow without fracture on radiograph. Magnetic resonance imaging revealed multiple reniform masses with avid contrast enhancement consistent with suppurative adenitis. She was admitted for irrigation and debridement. The patient underwent surgical debridement with removal of infected lymph nodes. Histology revealed necrotizing granulomatous lymphadenitis. Polymerase chain reaction was positive for B henselae. Antibody titer revealed B henselae immunoglobulin G titer of 1:512 (reference, 1:64), and negative immunoglobulin M titers were indicative of mature immune response. The patient was treated with azithromycin 250 mg tablets twice daily for 3 days followed by 3 days of the 250 mg tablet once daily. Follow-up showed resolution of infection without symptoms concerning for visceral organ infection.

Conclusion: While the patient's initial presentation was vague, a complete history, quick follow-up, and decisive intervention prevented significant sequelae such as visceral organ involvement.

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