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Cat-scratch disease in a patient with AIDS
1Department of Surgical Pathology, Albany Medical College, New York.
Insights
Cat-scratch disease (CSD) in an acquired immunodeficiency syndrome (AIDS) patient presented with unusual lymph node pathology. This case highlights diagnostic challenges and the effectiveness of antibiotic treatment in immunocompromised individuals.
Area of Science:
- Infectious Diseases
- Immunology
- Pathology
Background:
- Cat-scratch disease (CSD) is a bacterial infection typically caused by Bartonella henselae.
- Acquired immunodeficiency syndrome (AIDS) can alter the presentation of opportunistic and common infections.
- Lymphadenopathy is a common manifestation of CSD.
Observation:
- A patient with AIDS developed CSD with atypical lymph node findings.
- Histopathology revealed vacuolated macrophages and nuclear debris, differing from typical suppurative granulomas.
- Warthin-Starry stain and electron microscopy confirmed the presence of the CSD bacillus.
Findings:
- The lymph node pathology in this AIDS patient with CSD was significantly altered.
- The diagnostic criteria for CSD may need adjustment in immunocompromised populations.
- Antibiotic therapy led to clinical improvement.
Implications:
- This case underscores the importance of considering atypical presentations of CSD in patients with AIDS.
- Diagnostic methods like Warthin-Starry stain and electron microscopy are crucial for identifying the causative agent in altered pathological contexts.
- Understanding these variations is vital for accurate diagnosis and effective management of CSD in immunocompromised individuals.
Abstract:
A case of cat-scratch disease (CSD) in a patient with acquired immunodeficiency syndrome (AIDS) is reported. The lymph node pathologic characteristics were altered from those usually seen with CSD, showing clusters of vacuolated macrophages admixed with pycnotic nuclear debris instead of the usual suppurative granulomas. Evidence for the diagnosis was provided by Warthin-Starry stain and electron microscopic demonstration of the presumed CSD bacillus. Empiric treatment with antibiotics brought about clinical improvement. This case demonstrates the altered lymph node pathologic characteristics with CSD that may occur in a patient with AIDS.