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System for Focal, Closed-System Central Nervous System Injury
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Encephalopathy with retinitis due to cat-scratch disease
R A Smith1, B Scott, D W Beverley
1Department of Paediatrics, York Hospital, York, UK. robert.a.smith@york.nhs.uk
Developmental Medicine and Child Neurology
|November 28, 2007
Summary
Cat-scratch disease, caused by Bartonella henselae, can lead to severe neurological issues like encephalopathy. Early diagnosis and azithromycin treatment led to a full recovery in a pediatric case.
Area of Science:
- Infectious Diseases
- Neurology
- Ophthalmology
Background:
- Cat-scratch disease is caused by Bartonella henselae, a bacterium.
- While some Bartonella infections resolve spontaneously, others can be fatal without antibiotic treatment.
Observation:
- A 7-year-old male presented with a 2-week history of malaise and cervical lymphadenopathy.
- Symptoms progressed to fever, headache, vomiting, confusion, and meningism.
- Unusual retinal findings and evidence of Bartonella henselae infection were noted.
Findings:
- Lumbar puncture showed elevated cerebrospinal fluid protein, low glucose, and increased white blood cells.
- Antibody titers to Bartonella quintana supported the diagnosis of cat-scratch disease.
- The patient exhibited unexplained encephalopathy and atypical retinal findings.
Implications:
- This case highlights the potential for Bartonella henselae to cause severe neurological complications in children.
- Prompt diagnosis and treatment with azithromycin are crucial for favorable outcomes.
- Ophthalmological examination is important in diagnosing atypical presentations of cat-scratch disease.
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