A Rare Case of Bartonella Encephalitis With Hemiplegia

Abstract

The authors describe a 12-year-old girl with an atypical presentation of Bartonella encephalitis. She presented with fever and altered mental status and developed flaccid paralysis of her left upper extremity a day later. An electroencephalogram showed slowing over her right hemisphere. She had mild leukocytosis and bandemia, but her imaging and cerebrospinal studies were unrevealing. After five days, her symptoms resolved and she was discharged home on doxycycline due to suspicion for Bartonella encephalitis. The patient admitted to playing with a kitten two months prior, but she lacked the classic regional lymphadenopathy. Bartonella titers were sent during her hospitalization and returned positive after her discharge. Cat scratch disease neurologic manifestations are uncommon, with hemiplegia being exceedingly rare. This case illustrates that focal neurologic signs may develop during cat scratch disease infection and suggests that cat scratch disease encephalitis should be considered during evaluation of a pediatric patient with acute flaccid paralysis.

The Clinical Profile of Cat-Scratch Disease’s Neuro-Ophthalmological Effects

“…Rosas et al [ 176 ] described a case of cat-scratch-illness encephalitis associated with left-arm flaccid paralysis. The patient manifested an altered mental state and a probable seizure during the acute phase.…”

Zoonotic Disease Testing Practices in Pediatric Patients with Meningitis and Encephalitis in a Subtropical Region

“…Vector-borne and zoonotic pathogens can cause severe neuroinvasive disease in pediatric populations, resulting in meningitis, encephalitis, and even death [ 1 , 2 , 3 , 4 , 5 ]. Appropriate and timely diagnosis is essential to patient management and appropriate treatment, and it can inform public health and disease prevention measures.…”

Cat Scratch Disease-associated Encephalitis Followed by Parkinsonism

“…Although CSD is clinically characterized by self-limited regional lymphadenopathy with skin eruption and a low-grade fever, up to 2% of cases develop neurological involvement, typically in the form of encephalitis with a fever, headache, decreased arousal, and epilepsy (1)(2)(3). It is difficult to diagnose this type of encephalitis due to the lack of specific symptoms and examination findings (4)(5)(6). The natural clinical course of CSD is reportedly benign, whereby most patients completely recover, irrespective of typical lymphadenopathy or extranodal involvement, including encephalitis (1)(2)(3).…”