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Cat-scratch disease masquerading as post-transplant lymphoproliferative disorder
Paul Brian Ng Hung Shin1, Samuel X Tan1, Anthony Griffin1
1Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Journal of Surgical Case Reports
|February 9, 2024
Summary
In immunosuppressed patients, swollen lymph nodes can mimic malignancy. This case highlights cat-scratch disease as a treatable cause, distinct from post-transplant lymphoproliferative disorder.
Area of Science:
- Medical Case Study
- Immunology
- Infectious Disease
Background:
- Immunosuppressed patients, particularly transplant recipients on anti-rejection prophylaxis, present diagnostic challenges for lymphadenopathy.
- Distinguishing between infection and malignancy is critical for appropriate treatment and patient outcomes.
Observation:
- A transplant recipient presented with fever, malaise, pancytopenia, and an axillary lymph node.
- Initial investigations revealed Epstein-Barr virus positivity and atypical plasma cells on nodal biopsy, suggesting post-transplant lymphoproliferative disorder (PTLD).
Findings:
- Excisional biopsy and Bartonella henselae serology confirmed a diagnosis of cat-scratch disease.
- This zoonotic infection required a different treatment approach compared to PTLD.
Implications:
- Cat-scratch disease should be considered in the differential diagnosis of lymphadenopathy in immunosuppressed patients.
- Accurate differentiation between infectious mimics and PTLD is crucial for guiding therapy in transplant recipients.
