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Vague Presentation of Cat Scratch Disease in a Child
Alexander Crowley1, Bhumit Desai1,2, Sean Waldron1
1Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA.
Insights
Bartonella henselae infection can cause prolonged fever and swollen lymph nodes in children. Early diagnosis and treatment of this cat scratch disease prevented severe complications.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Prolonged fever or fever of unknown origin in children may indicate Bartonella henselae infection.
- Soft tissue infection can be a presenting symptom in pediatric Bartonella henselae cases.
Observation:
- A 10-year-old female presented with a "bug bite," fever, and cough, progressing to soft tissue swelling and suppurative adenitis.
- Magnetic resonance imaging revealed multiple masses consistent with suppurative adenitis.
- Histopathology showed necrotizing granulomatous lymphadenitis.
Findings:
- Polymerase chain reaction confirmed Bartonella henselae infection.
- Elevated Bartonella henselae immunoglobulin G titers indicated a mature immune response.
- Treatment with azithromycin led to infection resolution.
Implications:
- Prompt diagnosis and intervention are crucial for preventing severe sequelae, such as visceral organ involvement.
- This case highlights the importance of considering Bartonella henselae in pediatric patients with unexplained prolonged fever and lymphadenitis.
- Complete history and decisive treatment can lead to favorable outcomes in pediatric Bartonella henselae infections.
Abstract:
Background: Prolonged fever for more than a week or fever of unknown origin in pediatric patients with or without soft tissue infection should raise suspicion for Bartonella henselae infection. Case Report: A 10-year-old female presented to urgent care with a "bug bite" on the left ring finger, cough, and 2 to 3 days of low-grade fever. Ten days later, her symptoms progressed to soft tissue swelling of the left elbow without fracture on radiograph. Magnetic resonance imaging revealed multiple reniform masses with avid contrast enhancement consistent with suppurative adenitis. She was admitted for irrigation and debridement. The patient underwent surgical debridement with removal of infected lymph nodes. Histology revealed necrotizing granulomatous lymphadenitis. Polymerase chain reaction was positive for B henselae. Antibody titer revealed B henselae immunoglobulin G titer of 1:512 (reference, 1:64), and negative immunoglobulin M titers were indicative of mature immune response. The patient was treated with azithromycin 250 mg tablets twice daily for 3 days followed by 3 days of the 250 mg tablet once daily. Follow-up showed resolution of infection without symptoms concerning for visceral organ infection. Conclusion: While the patient's initial presentation was vague, a complete history, quick follow-up, and decisive intervention prevented significant sequelae such as visceral organ involvement.
