An Unusual Case of Cat-Scratch Disease from Bartonella quintana Mimicking Inflammatory Breast Cancer in a 50-Year-Old Woman

Povoski, Stephen P.; Spigos, Dimitrios G.; Marsh, W.

doi:10.1046/j.1524-4741.2003.09615.x

Cited by 13 publications

(11 citation statements)

References 13 publications

(25 reference statements)

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“…Using this staining of formalin-fixed tissues, you can increase the visibility of microorganism through the deposition of silver [13, 14]. However, in early lesions they may not appear [9]. …”

Section: Discussionmentioning

confidence: 99%

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Cat Scratch Disease Presenting as Breast Cancer: A Report of an Unusual Case

Conte

Libero

Varricchio

et al. 2013

Case Reports in Oncological Medicine

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Benign lymphoreticulosis (cat scratch disease, CSD) may have a clinical course that varies from the most common lymphadenitis localized in the site of inoculation, preceded by the typical “primary lesion,” to a context of severe systemic involvement. Among these uncommon clinical aspects, there is mammarian granulomatous lymphadenitis which may appear as a mastitis or a solitary intraparenchymal mass, giving the impression of a breast tumor. In these cases, intensive clinical, instrumental, and laboratory investigations are necessary to exclude malignancy. Because of its rarity, in equivocal cases, it is reasonable to use surgical excision for accurate histological examination. We report a case of CSD of the breast in a 59-year-old woman, analyzing the clinical, histopathological, and instrumental appearance and also performing a literature review.

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Section: Discussionmentioning

confidence: 99%

“…Usually, antimicrobial therapy is not required, because the process tends to limit itself. However, a positive response to different antimicrobials is reported in the literature, including azithromycin, which is considered the first-choice drug [9, 16]. The CSD of the breast is really an unusual clinical entity.…”

Section: Discussionmentioning

confidence: 99%

Cat Scratch Disease Presenting as Breast Cancer: A Report of an Unusual Case

Conte

Libero

Varricchio

et al. 2013

Case Reports in Oncological Medicine

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“…Despite this distinctive presentation, a variety of other clinical conditions may mimic IBC, such as congestive heart failure, lymphoma, leukemia, nephrotic syndrome, cat‐scratch disease, infections, and cutaneous metastasis from other neoplasms 6–9 . It is therefore imperative to perform a skin biopsy to confirm the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Metastatic esophageal carcinoma masquerading as inflammatory breast carcinoma

Nebesio¹,

Goulet²,

Helft³

et al. 2007

Int J Dermatology

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A 50-year-old Caucasian woman with a history of esophageal adenocarcinoma presented with a 3-week history of right breast swelling and progressive erythema. Twenty-two months prior to presentation, she had been diagnosed with adenocarcinoma of the esophagus (T3,N1,M1a) and underwent neoadjuvant chemoradiotherapy followed by surgical resection. On physical examination, the right breast was red, swollen (40% larger than the contralateral breast), tender to palpation, and warm to the touch (Fig. 1). No mass was palpable. On the basis of the clinical findings, inflammatory breast carcinoma was suspected. A punch biopsy revealed a poorly differentiated adenocarcinoma with extensive involvement of dermal lymphatics (Fig. 2). The clinical and histologic differential diagnosis included inflammatory breast carcinoma vs. metastatic esophageal adenocarcinoma to the skin of the breast. To resolve this question, immunohistochemical stains for estrogen and progesterone receptors and CDX-2 (BioGenex, San Ramon, CA, USA) were performed. CDX-2 is an intestinal homeobox gene expressed in gastrointestinal epithelium and gastrointestinal tumors. The tumor nuclei were positive for CDX-2 but negative for both steroid receptors (Fig. 3), confirming the diagnosis of metastatic esophageal adenocarcinoma.

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“…Transmission of the bacterium to humans occurs through an animal bite or scratch. Among the majority of the population, the resulting symptoms are self‐limiting . Typical clinical presentation includes the development of one or more small, reddish‐brown, erythematous papules, pustules, macules, vesicles, or ulcers at the infection site, along with lymphadenopathy .…”

mentioning

confidence: 99%

“…Among the majority of the population, the resulting symptoms are self‐limiting . Typical clinical presentation includes the development of one or more small, reddish‐brown, erythematous papules, pustules, macules, vesicles, or ulcers at the infection site, along with lymphadenopathy . CSD is most common in children and young adults under the age of 21 years .…”

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confidence: 99%

New‐Onset Refractory Status Epilepticus in an Adult with an Atypical Presentation of Cat‐Scratch Disease: Successful Treatment with High‐Dose Corticosteroids

et al. 2015

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New-onset refractory status epilepticus (NORSE) is defined as a sudden onset of refractory status epilepticus in patients who do not have a history of epilepsy. It is a neurologic emergency, and determining the underlying etiology is an important factor for effectively managing and predicting the prognosis of NORSE. We describe the case of a 28-year-old woman who was hospitalized with NORSE secondary to an unknown etiology. She did not respond to traditional anticonvulsant therapy, including benzodiazepines, fosphenytoin, propofol, and levetiracetam. The patient was placed on continuous electroencephalography (EEG) monitoring and was treated further with multiple antiepileptics, which were titrated aggressively based on EEG readings and therapeutic drug levels; despite this treatment, EEG monitoring revealed continued seizures. Thus, high-dose corticosteroids were started for seizure control. Her workup included computed tomography and magnetic resonance imaging of the head, a lumbar puncture, toxicology screening, and extensive testing for multiple infectious and inflammatory etiologies. The patient's history revealed recent exposure to a new cat. Serologic results were positive for Bartonella henselae, and she was diagnosed with cat-scratch disease (CSD). She did not have the typical presentation of symptoms of lymphadenopathy, however, which is common in CSD. Doxycycline 100 mg and rifampin 300 mg twice daily were added to the patient's anticonvulsant and corticosteroid therapy. She was hospitalized for a total of 26 days and discharged with only minor neurologic impairment (short-term memory deficits and minor cognitive problems). The patient was discharged receiving antiepileptics, antibiotics, and a corticosteroid taper. To our knowledge, this is the first clinically known case of NORSE secondary to CSD without typical CSD symptoms in the adult population. The patient failed to respond to traditional anticonvulsant therapy alone. With the addition of high-dose corticosteroids to aggressive anticonvulsant therapy, seizure control was achieved. Further studies are needed to determine the effectiveness of high-dose corticosteroid and anticonvulsant therapy followed by antibiotics in patients with NORSE secondary to CSD.

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An Unusual Case of Cat-Scratch Disease from Bartonella quintana Mimicking Inflammatory Breast Cancer in a 50-Year-Old Woman

Abstract: Cat-scratch disease of the breast has been previously reported. This report describes a very unusual case of cat-scratch disease of the breast caused by Bartonella quintana in which the clinical and radiographic presentation mimicked that of inflammatory breast cancer.

Cited by 13 publications

References 13 publications

Cat Scratch Disease Presenting as Breast Cancer: A Report of an Unusual Case

Cat Scratch Disease Presenting as Breast Cancer: A Report of an Unusual Case

Metastatic esophageal carcinoma masquerading as inflammatory breast carcinoma

New‐Onset Refractory Status Epilepticus in an Adult with an Atypical Presentation of Cat‐Scratch Disease: Successful Treatment with High‐Dose Corticosteroids

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