Atypical cat-scratch disease with acute high-grade fever and neuropsychiatric symptoms: a case report

To report an atypical case of neurological cat-scratch disease (NCSD) presenting with acute-onset fever and prominent neuropsychiatric manifestations in an older adult.

An 85-year-old East Asian man with a history of hypertension and coronary artery disease.

Three months after a cat scratch, the patient developed abrupt high-grade fever, followed by nocturnal delirium with visual hallucinations and a witnessed seizure-like episode, and later complained of occipital headache. Physical examination revealed mild bilateral axillary and left supraclavicular lymphadenopathy without focal neurologic deficits. Cerebrospinal fluid cultures and stains were negative for bacteria and fungi. Serum metagenomic next-generation sequencing (mNGS) detected Bartonella henselae. After antibiotic therapy, the fever and headache resolved.

Cat-scratch disease should be considered as a rare but important infectious etiology in patients presenting with febrile illness accompanied by delirium or other neuropsychiatric symptoms. Clinicians should carefully inquire about recent cat exposure or scratch history and consider early pathogen-directed empiric antibiotic therapy to minimize diagnostic delay and improve outcomes.