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Cat-scratch disease: an unusual cause of combative behavior
R A Harvey1, W J Misselbeck, R E Uphold
1Department of Surgery, Medical Center Hospital of Vermont, Burlington 05401.
The American Journal of Emergency Medicine
|January 1, 1991
Summary
Acute encephalitis, a rare symptom of cat-scratch disease, can present as confusion and violent behavior. This case highlights the importance of thorough evaluation for accurate diagnosis in emergency settings.
Area of Science:
- Neurology
- Infectious Diseases
- Internal Medicine
Background:
- Cat-scratch disease (CSD) is a bacterial infection typically transmitted by cats.
- While commonly presenting with lymphadenopathy, CSD can have diverse neurological manifestations.
- Acute encephalitis is an uncommon but serious complication of CSD.
Observation:
- A 27-year-old male presented with acute onset of confusion and violent behavior.
- Initial diagnosis considered drug abuse due to the patient's presentation.
- A comprehensive physical examination and laboratory workup were crucial for diagnosis.
Findings:
- The patient's symptoms were ultimately attributed to cat-scratch disease.
- Bartonella henselae, the causative agent of CSD, was identified as the cause of encephalitis.
- This case underscores that CSD can mimic other conditions presenting with altered mental status.
Implications:
- Emergency physicians must consider CSD in the differential diagnosis of acute encephalitis, especially in patients with altered mental status.
- A detailed patient history and physical examination are vital for identifying potential sources of infection.
- Prompt diagnosis and treatment of CSD-related encephalitis are essential to prevent severe neurological sequelae.