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Scratching Past Lymphadenopathy: A Case of Bartonella henselae Encephalitis
Insights
A 6-year-old boy with new seizures and altered mental status was diagnosed with Bartonella henselae infection. Prompt antibiotic treatment led to full recovery, highlighting the importance of exposure history in diagnosing pediatric encephalitis.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Zoonotic Infections
Background:
- Bartonella henselae is a zoonotic bacterium that can cause cat-scratch disease.
- Encephalitis is inflammation of the brain, often presenting with neurological symptoms.
Observation:
- A previously healthy 6-year-old boy experienced new-onset seizures, altered mental status, prolonged fever, and abdominal complaints.
- Initial neurological examinations were inconclusive, and symptoms improved spontaneously.
- Serum antibody titers were positive for Bartonella henselae (immunoglobulin G and M), and splenic and liver micro-abscesses were detected.
Findings:
- The patient's symptoms resolved after a course of antibiotics.
- Splenic and liver micro-abscesses showed resolution.
- The patient returned to his baseline cognitive and neurological status.
Implications:
- This case underscores the critical role of a detailed exposure history, particularly to animals like kittens, in identifying infectious causes of encephalitis in children.
- Early recognition and treatment of Bartonella henselae infection can prevent severe neurological sequelae.
- Clinicians should consider zoonotic infections in the differential diagnosis of unexplained pediatric neurological and systemic symptoms.
Abstract:
A previously healthy 6-year-old boy presented with new onset seizure activity and altered mental status. His prehospital course included prolonged fever, vague abdominal complaints, and unusual behavior. Neurological testing was unrevealing, and his symptoms slowly improved without intervention. His primary pediatrician had ordered serum antibody titers to Bartonella henselae for testing of prolonged fever in the setting of exposure to a kitten; these were found to be positive for both immunoglobulin G and immunoglobulin M. Further examination for organ involvement revealed splenic and liver micro-abscesses. After completion of his antibiotic course, the patient returned to his cognitive and neurologic baseline with resolution of his abdominal abscesses. This case emphasizes the importance of obtaining a thorough exposure history when evaluating for infectious causes of encephalitis. [Pediatr Ann. 2020;49(8):e359-e362.].
