Cat Scratch Disease Mimicking Richter's Syndrome in a Patient with Chronic Lymphocytic Leukemia

Abstract

Richter's Syndrome is a highly refractory and usually fatal condition. It occurs as a result of transformation of chronic lymphocytic leukemia (CLL) or low grade lymphoma into highly aggressive lymphoma. Patients usually present with rapidly enlarging lymph nodes and systemic symptoms like night sweats, fever and weight loss. We are reporting a case of CLL presenting with similar symptoms. Initial suspicion of Richter's Syndrome proved wrong when lymph node biopsy did not reveal evidence of high grade lymphoma. Instead it showed findings consistent with cat scratch disease (CSD), later confirmed by serology. To our knowledge this is the first reported case of CSD in a patient with CLL.

Adult systemic cat scratch disease associated with therapy for hepatitis C

“…This is illustrated by the experience with B. henselae in AIDS patients, where the same pathogen that causes self-limited regional lymphadenopathy in immunocompetent hosts, causes bacillary angiomatosis and peliosis hepatis [18]. However, other immunodeficient states, such as chronic lymphocytic leukemia and T cell lymphoma, can also trigger dissemination of CSD [19,20]. In fact, the immunomodulatory effects of co-infection with EBV may have been responsible for one case of disseminated CSD [21].…”

Cat-Scratch Disease In Adult Hospitalized For Prolonged-Fever Associated With Multiple Lymphadenopathies and Weight Loss

“…Indeed, the severity of clinical presentation correlates with the status of the hosts’ immune system, as the role of the host immune response to Bartonella henselae in the disease manifestation has been illustrated in patients with Acquired Immuno- Deficient Syndrome (AIDS) in which Bartonella henselae progresses to systemic infection more often, including bacillary angiomatosis or bacillary peliosis hepatis, while in immunocompetent patients, a self-limited regional lymphadenopathies involving resulting from a strong cellular immune response to bacterium are usually observed [6, 7]. However, the dissemination of Bartonella henselae is observed in other immunodeficient states, such as chronic lymphocytic leukaemia and T cell lymphoma [8, 9]. In fact, our observation is in concordance with an immune response in immunocompetent adult as neither a deficit in leukocytes and lymphocytes number nor a negative HIV serology were observed.…”

“…As some patients might have a concurrent mycobacteriosis chronic pathology or malignant disease, therefore histological analysis of lymph node biopsy specimens should be routinely performed in patients with suspected Cat-scratch disease [10]. This is amplified by observating Bartonella henselae infection mimicking a splenic lymphoma, Richter’s syndrome in patient with chronic lymphocytic leukemia or multiple sclerosis [8, 11, 12]. Similarly, lymph node enlargement is a common medical problem observed both in infectious diseases caused by bacterial, viral, protozoal agents and in malignancies or lymphoproliferative diseases [13].…”

Human Bartonella Infection: A Review of Literature

“…Infection disease resembling lymphoma is commonly reported, especially when lymphadenopathy of the neck and abdomen is involved [31]. The clinical symptoms are even more confusing when splenomegaly occurs together with "B symptoms" -weight loss, night sweats and prolonged fever [32]. Another unusual presentation involves a patient with a single soft tissue mass covering a lytic cranial lesion suggesting Histocytosis X [33].…”