Hepatosplenic Cat Scratch Disease in Immunocompetent Adults

Abstract

Cat-scratch disease (CSD) is the most frequent presentation of Bartonella henselae infection. It has a worldwide distribution and is associated with a previous history of scratch or bite from a cat or dog. CSD affects children and teenagers more often (80%) than adults, and it usually has a self-limiting clinical course. Atypical clinical course or systemic symptoms are described in 5%–20% of patients. Among them, hepatosplenic (HS) forms (abscess) have been described. The majority of published cases have affected children or immunosuppressed patients. Few cases of HS forms of CSD in immunocompetent adult hosts have been reported, and data about the management of this condition are scarce. Herein, we present 3 new cases of HS forms of CSD in immunocompetent adults and review 33 other cases retrieved from the literature. We propose an approach to clinical diagnosis and treatment with oral azithromycin.

Atypical manifestation of cat‐scratch disease: isolated epigastric pain in an immunocompetent, 12‐year‐old child

“…In the classical hepatosplenic form of the disease, regional lymphadenitis and/or identifiable inoculation site are rarely present on clinical examination, but more than half of patients present with enlarged liver and/or enlarged spleen . Over 60% patients with hepatosplenic CSD also have associated dull episodic abdominal pain which is localized in periumbilical region . Our patient, in addition to not having hepatosplenic enlargement, had only a clearly epigastric pain as sole complaint.…”

“…Based on our past experience of successful management of other forms of CSD in children with Azithromycin ® , we tend, like Garcia et al. , to recommend this drug as first choice. The treatment duration remains, however, matter of debate with adult patients having been treated from 5 to 21 days as reported by Garcia et al.…”

The cat did it: erythema nodosum and additional atypical presentations ofBartonella henselaeinfection in immunocompetent hosts

“…However, the presence of IgM antibodies and high-titre IgG against B. henselae, the bilateral axillary lymphadenopathy with necrosis and granulomas by imaging (figure 1) and biopsy, the absence of any other identifiable cause and favourable outcome strongly support the diagnosis in a patient with daily contact with cats 1 4. In addition to the erythema nodosum, the patient’s splenomegaly, para-aortic lymph node enlargement and possibly the hypodense liver lesions, although not biopsied, likely represent visceral involvement,5 typically associated with minimal laboratory tests abnormalities.…”

Infección por Bartonella henselae con compromiso de sistema nervioso central, asociado a un papiloma del plexo coroídeo

“…Las presentaciones atípicas (5-20%) 9 se describen generalmente en pacientes inmunocomprometidos, siendo la ocular la más frecuente 1,10 , aunque también se puede presentar con compromiso hepato-esplénico, del SNC, óseo, endocárdico, compromiso pleuro-pulmonar, renal, hematológico y cutáneo 1 . El síndrome febril prolongado o síndrome mononucleósico pueden darse, con o sin compromiso inmunitario.…”