An unusual presentation of cat-scratch disease

Abstract

Cat-scratch disease (CSD) is a relatively common entity, particularly in children. The most common sites of involvement are the axillary lymph nodes, followed by cervical, pre-auricular and submandibular lymph nodes. We present a case of cat-scratch disease in which the initial clinical features were indistinguishable from those of acute bacterial tonsillitis with jugulodigastric lymphadenopathy. This previously unreported apparent mode of presentation is discussed with reference to the current understanding of the disease.

Felinosis: the elusive-cat scratch disease

“…8 Axillary lymph nodes followed by cervical, pre-auricular and submandibular lymph nodes are the most common sites of involvement. 1 The disease is self-limiting with the primary inoculation lesion occurring in atleast 90% of patients which usually arises within 3-10 days following a cat scratch, bite or lick. The lesion progresses through vesicular, erythematous and papular stage which lasts for 1-3 weeks.…”

“…Cervical lymphadenopathy is more common in children and occurs secondary to bacterial or viral infection of oropharyngeal or cutaneous origin in most occasion. 1 Tuberculosis, inflammatory disorders and neoplasia are some of the other causes. A detailed history and thorough physical examination together with laboratory tests may be necessary to arrive at a diagnosis.…”

“…A detailed history and thorough physical examination together with laboratory tests may be necessary to arrive at a diagnosis. 1 Cat scratch disease (CSD) also known as felinosis or subacute regional lymphadenitis is a benign infectious disease caused by an intracellular bacterium, Bartonella henselae. 2 Children are more frequently affected following a scratch or bite of a cat.…”

“…2 Axillary lymph nodes followed by cervical, pre-auricular and submandibular lymph nodes are the most common sites of involvement. 1 Most patients develop regional lymphadenopathy, preceded by an erythematous papule at the site of inoculation. Healthy people clear infection without treatment, but in 5-14% the organism disseminate systemically causing pneumonia, encephalitis and hepatitis.…”

Atypical presentation of severe cat scratch disease: suspected from patient history and physical findings

“…On the other hand, atypical symptoms, observed in 5%–9% of cases, may involve Parinaud’s oculoglandular syndrome, encephalitis, endocarditis, haemolytic anaemia, hepatosplenomegaly, glomerulonephritis, pneumonia, recurrent bacteraemia and osteomyelitis 5. Instances of CSD presenting with cough6 and tonsillitis7 have also been documented. Furthermore, diverse rash types are reported, with maculopapular rashes like those in the current case occurring in 5%–13% of patients 8…”