[Acute generalized cat scratch disease in myelodysplastic syndrome]

Area of Science:

• Infectious Diseases
• Dermatology
• Immunology

Background:

• Cat scratch disease (CSD) is usually a mild infection caused by Bartonella henselae.
• Immunocompetent individuals typically develop a localized papule at the inoculation site.
• Myelodysplastic syndrome (MDS) can impair immune function, potentially altering CSD presentation.

Observation:

• A 73-year-old male with myelodysplastic syndrome presented with generalized petechial, papular, and vasculitic skin lesions.
• The patient had a confirmed diagnosis of cat scratch disease via lymph node biopsy.
• Diagnosis was confirmed by Warthin-Starry staining identifying the causative organism.

Findings:

• The patient's CSD manifested with atypical, widespread cutaneous vasculitis, unlike typical presentations.
• Treatment with erythromycin for three weeks led to progressive clearance of the skin lesions.
• Serological markers, including IgG antibodies against Bartonella species, showed delayed but significant increases.

Implications:

• This case highlights the potential for atypical and severe cutaneous manifestations of CSD in immunocompromised patients.
• Early diagnosis and treatment with antibiotics like erythromycin are crucial for managing severe CSD.
• Understanding altered CSD presentations in immunocompromised individuals is vital for accurate diagnosis and patient care.