[Tumor-like lesion in a 13-year-old boy: post-COVID bartonellosis]

A 13-year-old male patient presented in the pediatric emergency room in our hospital with fever, cough, loss of smell and an approximately 2 × 3 cm diameter right neck mass in the supraclavicular region. 24 days earlier, the documented nasopharyngeal COVID–19 rapid test resulted positive. Oral antibiotic therapy was prescribed for 7 days (clarithromycin, 2 × 500 mg) and before emission, blood samples were taken for serological examinations. After 2 days, the patient returned to the hospital because of the growth of the unilateral neck mass. Fine-needle aspiration cytology ended with the cytological diagnosis of C3, without excluding the malignant characteristics of the aspirated cells. Neck and chest CT described an approx. 60 × 46 × 40 mm supraclavicular inhomogenic neck lesion without invasion of the intrathoracal region with potential signs of abscess formation and compression on the jugular vein. In time, the serologic examination for Bartonella henselae resulted positive. Total surgical removal of the right-sided supraclavicular neck tumor was made. The pathological examination described necrotizing and non-necrotizing granulomas without atypical cells. Although the effect of SARS-CoV-2 infection on the clinical course of bartonellosis has not yet been described in the literature, our case shows that co-occurrence of the two diseases can cause more serious complications of an otherwise harmless self-healing disease, which in this case partly resisted to the antibiotic treatment and was solved by the total surgical removal of the tumor-like neck lesion. Orv Hetil. 2024; 165(9): 351–355.