Hepatosplenic Cat Scratch Disease and Prolonged Fever: When To Add Corticosteroids?

Abstract

The indications for use of corticosteroids for persistent fever in cat scratch disease are controversial. We report the case of a 5-year-old boy diagnosed with systemic cat scratch disease, who presented with fever for 28 days and focal hepatosplenic lesions. He did not show improvement despite antibiotic treatment for 4 weeks, however, he became afebrile 24 hours after the administration of corticosteroids.

A pediatric case of cat scratch disease complicated by meningitis diagnosed by Metagenomic Next-generation Sequencing

“…There are also no standard treatments protocols for CSD with meningitis at present, and doxycycline with rifampin is suggested for children older than 8 years, for a duration of 4-6weeks [21]. Exsisting researches show that oral prednisone of 6 weeks is suspected to be beni cial in patients with neurological involvement or severe compliacations [21][22][23]. In this case, the patient was diagnosed with CSD complicated by meningitis, and was cured using a regimen of doxycycline, rifampin, and oral prednisone.…”

Atypical Cat Scratch Disease With Splenic Lesion Mimicking Kawasaki Disease in a Healthy 5-Year-old Girl

“…However, the patient may have recovered spontaneously during the natural course of the illness. Corticosteroids have been proposed as an adjunctive therapy for hepatosplenic CSD refractory to antibiotics, [21][22][23] but the evidence is still limited, and this routine use is not recommended for Bartonella infection in general. 1,24 Furthermore, as mentioned earlier, patients with atypical CSD did not recover following IVIG treatment, [9][10][11][12] suggesting that IVIG may be ineffective in treating CSD.…”