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[Cat scratch disease showing clinical picture resembling tuberculous lymphadenitis: a case report]
1Department of Internal Medicine, Keiju General Hospital.
Insights
Cat scratch disease (CSD) can mimic tuberculosis. Diagnosis involves considering Bartonella henselae infection, especially after cat exposure, confirmed by serology and pathology.
Area of Science:
- Infectious Diseases
- Microbiology
- Immunology
Background:
- Granulomatous lymphadenitis can present with varied etiologies, often mimicking other conditions like tuberculosis.
- Early diagnostic indicators for less common infections may be missed without thorough patient history and specific serological testing.
Observation:
- A 61-year-old woman presented with a left inguinal mass initially suspected to be tuberculosis due to granulomas and caseous necrosis.
- Initial pathological examination was inconclusive for tuberculosis; however, subsequent re-examination revealed suppurative granulomas.
- Detailed history revealed significant cat contact, prompting investigation for Bartonella henselae.
Findings:
- Enzyme immunoassay confirmed elevated IgG antibodies to Bartonella henselae, indicative of current infection.
- Histopathological re-evaluation showed suppurative granulomas alongside caseous ones, aligning with cat scratch disease.
- Negative IgM titers, coupled with rising and falling IgG levels, supported a recent Bartonella henselae infection.
Implications:
- Cat scratch disease (CSD) should be a key differential diagnosis in cases of granulomatous lymphadenitis.
- Thorough patient anamnesis, specifically inquiring about animal contact (e.g., cats), is crucial for diagnosing CSD.
- Integrated diagnostic approaches combining clinical presentation, histopathology, and serological testing are vital for accurate CSD diagnosis.
Abstract:
On February 18th, 1997, a 61-year-old woman visited our hospital because of a left inguinal mass. On physical examination, the mass was soft without inflammatory sign. About one month later, the node was excised. Pathological examination revealed granulomas with caseous necrosis and Langhans giant cells, suggesting tuberculosis, although acid fast stain was negative. Thereafter, re-history taking in detail disclosed that a kitten had often scratched her. We reexamined the pathology and checked her for serum antibodies to Bartonella henselae, the etiological microbe of cat scratch disease (CSD), using enzyme immunoassay. Histopathological reexamination of the excised mass revealed suppurative granulomas in addition to caseous ones. The level of IgG (negative: < 12 units) to B. henselae was 78 units on March 25th, 138 units on April 19th, and 18 units on July 18th, while the level of IgM (negative: < 12 units) was negative at each determination. These serological results strongly suggested current infection of B. henselae. The diagnosis of CSD could be established based on the history and the laboratory findings. When one encounters a case of granulomatous lymphadenitis, CSD should be considered for the differential diagnosis, and in this regard, anamnesis about contact with cats should be asked.
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