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Cat scratch disease causing hepatic masses after liver transplant
Kavitha R Thudi1, Jeffrey T Kreikemeier, Nancy J Phillips
1Gastroenterology and Hepatology Division, Department of Internal Medicine, Saint Louis University Hospital, St Louis, MO, USA.
Summary
Cat scratch disease (CSD) in liver transplant recipients is rare, especially with distinct liver lesions. Diagnosis of Bartonella henselae infection in these patients may require tissue PCR testing when serology is unclear.
Area of Science:
- Hepatology
- Transplant Surgery
- Infectious Diseases
Background:
- Liver transplant recipients are susceptible to opportunistic infections.
- Hepatic cat scratch disease (CSD) is an uncommon complication in this population.
- Discrete liver lesions in grafts are an unprecedented presentation of CSD.
Observation:
- A 52-year-old liver transplant recipient presented with fever of unknown origin 2.7 years post-transplant.
- Multiple, diffuse, discrete liver lesions developed despite extensive work-up.
- Diagnosis required subsegmental liver resection for definitive identification of Bartonella henselae.
Findings:
- Histopathology confirmed CSD, and PCR testing of resected tissue was positive for Bartonella henselae.
- Serological tests for Bartonella henselae were equivocal, likely due to immunosuppression.
- The patient responded rapidly to doxycycline, with fever resolution and lesion reduction on CT scan.
Implications:
- Cat scratch disease should be considered in liver transplant patients with fever and liver lesions.
- PCR testing of tissue is crucial for diagnosing CSD when serology is equivocal in immunosuppressed patients.
- Early diagnosis and treatment with antibiotics like doxycycline can lead to favorable outcomes.
