Unilateral Submandibular Lymphadenopathy in a 7-Year-Old Boy

Abstract

Cat-scratch disease is a bacterial infection caused by Bartonella henselae that most commonly presents with fever and subacute regional lymphadenopathy after being scratched by a domestic or feral cat. 1 It is one of the most common causes of subacute or chronic lymphadenopathy in children and should be considered in any pediatric patient presenting with lymphadenopathy or fever of unknown origin. 2 We present a case of a 7-year-old boy with a facial cutaneous lesion and submandibular lymphadenopathy after being scratched by a cat, presumptively diagnosed with cat-scratch disease. Case PresentationA 7-year-old boy presented to the outpatient pediatric clinic with a 1-week history of left-sided facial swelling (Figures 1-4).History. The patient had no significant past medical history. Three weeks prior, he presented to a local urgent care clinic with a vesicle on his left cheek and slightly swollen submandibular lymph node after being scratched by a kitten. His condition was diagnosed as lymphadenitis, and he was prescribed cephalexin. At the time, the lymphadenitis was attributed to recent filling of dental caries. Despite completing a 10-day course of cephalexin, he began to develop increased leftsided facial swelling without associated tenderness or erythema. The swollen area continued to enlarge over the next week. The patient had no associated symptoms of fever, eye discharge or redness, congestion, fatigue, sore throat, or change in appetite or activity. His mother denied prior history of lymphadenopathy or any change in color or drainage.