Life-threatening cat-scratch disease in an immunocompromised host.

Area of Science:

• Infectious Diseases
• Nephrology
• Immunocompromised Hosts

Background:

• Cat-scratch disease (CSD) is typically a benign, self-limiting zoonotic infection.
• Immunocompromised individuals, such as renal allograft recipients, are at risk for severe CSD manifestations.

Observation:

• A renal allograft recipient presented with fever, headache, and arthralgias following cat exposure.
• The patient later developed refractory hypotension, metabolic acidosis, pulmonary infiltrates, and encephalopathy, consistent with septic shock.
• Bartonella henselae was identified in biopsy specimens from the inoculation site and lymph node.

Findings:

• The patient's severe illness was attributed to systemic cat-scratch disease.
• Intravenous administration of sulfamethoxazole/trimethoprim, erythromycin, and tobramycin correlated with clinical improvement.
• Diagnosis was confirmed by clinical presentation and Warthin-Starry silver stains revealing pleomorphic bacilli.

Implications:

• This case highlights the potential for severe, systemic CSD in immunocompromised patients.
• Vigorous antibiotic therapy may be necessary to manage life-threatening complications of CSD.
• Clinicians should consider CSD in immunocompromised patients with unexplained febrile illness and shock-like symptoms.