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An unusual outcome in a child with hepatosplenic cat-scratch disease
Dalibor Vukelić1, Branka Benić, Dragomir Bozinović
1University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia. bfm@bfm.hr
Insights
Cat-scratch disease (Bartonella henselae infection) typically presents in immunocompetent children after cat contact. This case highlights a severe hepatosplenic form requiring splenectomy despite treatment.
Area of Science:
- Infectious Diseases
- Pediatrics
- Microbiology
Background:
- Cat-scratch disease, caused by Bartonella henselae, is common in immunocompetent children following cat exposure.
- Typical symptoms include a papule at the inoculation site and regional lymphadenopathy.
- Atypical presentations and severe forms can occur, particularly in immunocompromised individuals.
Observation:
- This report details a 6-year-old immunocompetent boy with the rare hepatosplenic form of cat-scratch disease.
- The patient presented with significant liver and spleen involvement.
- Despite prompt diagnosis and extended antimicrobial therapy, the condition necessitated surgical intervention.
Findings:
- The hepatosplenic form of Bartonella henselae infection can lead to severe complications in children.
- Early diagnosis and antimicrobial treatment may not always prevent the need for splenectomy in severe cases.
- Granulomatous involvement of the liver and spleen is a recognized, albeit less common, manifestation.
Implications:
- Highlights the spectrum of Bartonella henselae infections in children, including severe hepatosplenic disease.
- Emphasizes the importance of considering atypical presentations of cat-scratch disease.
- Underscores the potential need for aggressive management, including splenectomy, for severe hepatosplenic Bartonella henselae infection in pediatric patients.
Abstract:
Typical cat-scratch disease (Bartonella henselae infection) in an immunocompetent child is usually associated with a history of scratch, bite or intimate contact with a cat. Most patients develop a non-tender papule in the scratch line after three to ten days. This may persist for only a few days or as long as two to three weeks. During the next two weeks or more, regional lymph nodes that drain the area gradually enlarge and then slowly resolve in more than 10% of patients. The nodes develop overlying erythema and may suppurate. Atypical forms of cat-scratch disease occur in a minority of cases and are characterized by ocular or neurological manifestations, hepatosplenic involvement, vertebral osteomyelitis, endocarditis etc. Immunocompromised individuals with B. henselae infection may develop bacillary angiomatosis, bacillary peliosis, and relapsing bacteremia. There have been several reports of hepatosplenic granulomas caused by B. henselae in immunocompetent children. We report a case of a 6-year-old boy with the hepatosplenic form of cat-scratch disease. Despite early diagnosis and long-term antimicrobial treatment, splenectomy could not be avoided.
