Hepatosplenic cat scratch disease diagnosed by serology

Abstract

Sir: Cat scratch disease (CSD) is a self-limited syndrome characterized by subacute regional lymphadenopathy after contact with cats. The aetiological agent has been controversial, but recent ®ndings have indicated Bartonella (previously Rochalimaea) henselae as a major cause [1,3]. The frequency of abdominal complications in CSD may be underestimated. They include hepatosplenomegaly, hepatitis, hepatic and splenic granulomas, intra-abdominal adenopathy and peritonitis [5]. We report one case of hepatosplenic CSD diagnosed with a recently developed commercial serological test.A previously healthy 7-year-old girl was admitted to hospital for the evaluation of daily fever 38±40°C for 1 month and accompanied by vague abdominal pain. She had a history of multiple scratches by kittens and her physical examination was normal, cutaneous lesions, lymphadenopathy and hepatosplenomegaly being absent.Laboratory tests revealed an erythrocyte sedimentation rate of 97 mm/h and a C-reactive protein of 24 mg/dl. Results of complete blood counts, blood chemistries and liver function tests were normal. Abdominal sonogram showed multiple round 1±3 cm hypo-echoic masses throughout the liver, spleen and upper retroperitoneal areas. Similar lesions (enhanced with contrast) were seen on a CT scan.Histological examination of a liver biopsy demonstrated granulation tissue with an intense acute in¯ammatory cell in®ltrate. There was insucient sample to perform the Warthin-Starry stain. We were unable to isolate Bartonella henselae from the biopsy specimen, despite prolonged incubation (4 weeks in 5% CO 2 ) in rich blood medium.The patient recovered 8 weeks after the onset of illness, her imaging ®ndings improved in 3 months and she was still symptom free 1 year later. Two sera from the patient, obtained at admission and 4 weeks later, were tested for antibody to B. henselae and B. quintana, using a commercial indirect¯uorescent assay test (MRL Diagnostics), and revealed high titres of antibodies to both species in both samples (Table 1).In our case the diagnosis was suspected on the basis of cat exposure history and the similarities with ®ndings in other reported patients. The high IgG titres for B. quintana are a cross-reaction for common antigen determinants, while the IgM response is more species-speci®c. Dalton and coworkers [3] showed the usefulness of Bartonella immuno¯uorescence assay for CSD diagnosis taking serological analyses on 3088 samples of 600 patients presumed to have CSD and found elevated titres to B. quintana in 94% of positive sera to B. henselae.In our patient exploratory laparotomy was not considered necessary because the percutaneous liver biopsy con®rmed that the lesions were granulomatous and not malignant, and she recovered rapidly. The in¯uence of antibiotics on the course of hepatosplenic CSD is unclear; however, some authors report excellent response to gentamicin [2] or rifamicin [4]. References 1. Anderson BE, Sims K, Regnery RL, et al (1994) Detection of Rochalimaea henselae DNA in specimens from cat scratc...

Hepatic Lesions in an Immunocompetent Child Previously Treated for Cat Scratch Disease With Azithromycin

“…In older reports, some hepatosplenic lesions resolved without treatment within 2 to 6 months. 15 , 17 - 20 However, currently, a prolonged course of antibiotics is typically recommended. 1 Regimens reported to be effective in observational studies include azithromycin, clarithromycin, ciprofloxacin, doxycycline, rifampin, trimethoprim-sulfamethoxazole, and parenteral gentamicin.…”