Hepatosplenic Cat Scratch Disease and Prolonged Fever: When To Add Corticosteroids?

Area of Science:

• Pediatric Infectious Diseases
• Immunology

Background:

• Cat scratch disease (CSD) is a bacterial infection typically transmitted by cats.
• Systemic CSD can manifest with prolonged fever and organ involvement, such as hepatosplenic lesions.
• The use of corticosteroids for persistent fever in CSD remains a topic of debate.

Observation:

• A 5-year-old boy presented with systemic cat scratch disease, characterized by 28 days of persistent fever.
• The patient exhibited focal lesions in the spleen and liver.
• Standard antibiotic therapy for 4 weeks did not resolve the fever.

Findings:

• Administration of corticosteroids led to a rapid resolution of fever within 24 hours.
• This suggests a potential anti-inflammatory or immunomodulatory role of corticosteroids in managing severe CSD symptoms.
• The patient's fever subsided without further complications.

Implications:

• Corticosteroids may represent a valuable therapeutic option for refractory fever in systemic cat scratch disease.
• Further research is warranted to establish clear guidelines for corticosteroid use in CSD management.
• This case highlights the importance of considering adjunctive therapies for severe presentations of CSD.