[Mediastinal form of cat-scratch disease]

Area of Science:

• Pediatric Infectious Diseases
• Medical Case Reports
• Immunology

Background:

• Cat-Scratch Disease (CSD) commonly presents as chronic lymphadenopathy in children, typically a mild illness.
• Unusual manifestations of CSD include Parinaud's oculoglandular syndrome, neurological complications, osteomyelitis, and mediastinal lymphadenopathy.
• Accurate diagnosis can be challenging due to varied presentations and potential misinterpretation of histopathological findings.

Observation:

• A 14-year-old boy presented with an atypical mediastinal mass, initially suspected to be other conditions due to pseudo-tubercular folliculi on histopathology.
• Diagnostic confirmation relied on a strongly positive Hanger-Rose reaction and specific serological assays.
• The diagnostic workup included tests for psittacosis, ornithosis, lymphogranuloma venereum, and trachoma.

Findings:

• The case underscores the importance of considering CSD even with rare presentations like mediastinal masses.
• Biological examinations, including serology, were crucial for definitive diagnosis, overcoming misleading histopathological clues.
• This report adds to the limited documented cases of CSD presenting as mediastinal lymphadenopathy.

Implications:

• Clinicians should maintain a high index of suspicion for CSD in pediatric cases with unexplained lymphadenopathy or mediastinal masses.
• The study highlights the utility of serological testing in diagnosing atypical CSD cases.
• Further research into the diverse clinical spectrum and diagnostic challenges of CSD is warranted.