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Hepatosplenic cat-scratch fever
Clinical Picture
Hepatosplenic cat-scratch fever Federico R Laham, Sheldon L Kaplan Lancet Infect Dis 2008; 8: 140 Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA (F R Laham MD, Prof S L Kaplan MD) Correspondence to: Dr Sheldon L Kaplan, Department of Pediatrics, Section of Infectious Diseases, Texas Children’s Hospital, 6621 Fannin, Houston, TX, USA. Tel +1 832 824 4330; fax +1 832 825 4347; [email protected]
A 12-year-old boy presented with a 3-week history of progressive right submandibular swelling, fever, and 4·5 kg weight loss. His pediatrician prescribed a 10-day course of co-trimoxazole for bacterial lymphadenitis on illness day 5. Owing to the lack of improvement, the patient saw an otolaryngologist who recommended a 5-day regimen of azithromycin for suspected cat-scratch disease on illness day 14. Serological studies for Bartonella spp were submitted. The mass continued to increase in size, fever persisted, and right-sided abdominal pain as well as bilateral shoulder ache developed. The patient was hospitalised, had incision and drainage of the mass, and intravenous clindamycin (10 mg/kg every 8 h). More than 10 mL of haemopurulent
fluid was collected, but Gram stain was negative and cultures processed using routine media were sterile. When the infectious diseases service was consulted and upon further questioning, the patient recalled being injured on his lip by a kitten that his 3-year-old brother had thrown at his face almost 2 months before. Physical examination identified a healing papule on the buccal surface of the upper lip (figure), and tenderness to palpation of the right upper abdominal quadrant. Follow-up on the serologies done previously at a nonreference laboratory revealed qualitative IgG and IgM titres positive for Bartonella henselae. An abdominal ultrasound revealed hepatosplenomegaly with multiple hepatic and splenic hypoechoic lesions. The patient was subsequently discharged to complete a 14-day treatment with oral rifampicin. At follow up, 1 month later, he was fully recovered. Quantitative serum antibodies analysed by the Texas Department of Health were positive for Bartonella quintana (1:32 768) and B henselae (1:2048). Hepatosplenic cat-scratch disease commonly presents as fever of unknown origin or persistent abdominal pain after a symptom-free period following intimate contact with a kitten. Significant serological cross-reactivity exists between Bartonella species. Antibiotic treatment may decrease the duration of fever and other symptoms such as abdominal pain. Conflicts of interest We declare that we have no conflicts of interest. Acknowledgments We thank Carol J Baker for her valuable comments on this manuscript.
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http://infection.thelancet.com Vol 8 February 2008
Hepatosplenic cat-scratch fever Federico R Laham, Sheldon L Kaplan Lancet Infect Dis 2008; 8: 140 Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA (F R Laham MD, Prof S L Kaplan MD) Correspondence to: Dr Sheldon L Kaplan, Department of Pediatrics, Section of Infectious Diseases, Texas Children’s Hospital, 6621 Fannin, Houston, TX, USA. Tel +1 832 824 4330; fax +1 832 825 4347; [email protected]
A 12-year-old boy presented with a 3-week history of progressive right submandibular swelling, fever, and 4·5 kg weight loss. His pediatrician prescribed a 10-day course of co-trimoxazole for bacterial lymphadenitis on illness day 5. Owing to the lack of improvement, the patient saw an otolaryngologist who recommended a 5-day regimen of azithromycin for suspected cat-scratch disease on illness day 14. Serological studies for Bartonella spp were submitted. The mass continued to increase in size, fever persisted, and right-sided abdominal pain as well as bilateral shoulder ache developed. The patient was hospitalised, had incision and drainage of the mass, and intravenous clindamycin (10 mg/kg every 8 h). More than 10 mL of haemopurulent
fluid was collected, but Gram stain was negative and cultures processed using routine media were sterile. When the infectious diseases service was consulted and upon further questioning, the patient recalled being injured on his lip by a kitten that his 3-year-old brother had thrown at his face almost 2 months before. Physical examination identified a healing papule on the buccal surface of the upper lip (figure), and tenderness to palpation of the right upper abdominal quadrant. Follow-up on the serologies done previously at a nonreference laboratory revealed qualitative IgG and IgM titres positive for Bartonella henselae. An abdominal ultrasound revealed hepatosplenomegaly with multiple hepatic and splenic hypoechoic lesions. The patient was subsequently discharged to complete a 14-day treatment with oral rifampicin. At follow up, 1 month later, he was fully recovered. Quantitative serum antibodies analysed by the Texas Department of Health were positive for Bartonella quintana (1:32 768) and B henselae (1:2048). Hepatosplenic cat-scratch disease commonly presents as fever of unknown origin or persistent abdominal pain after a symptom-free period following intimate contact with a kitten. Significant serological cross-reactivity exists between Bartonella species. Antibiotic treatment may decrease the duration of fever and other symptoms such as abdominal pain. Conflicts of interest We declare that we have no conflicts of interest. Acknowledgments We thank Carol J Baker for her valuable comments on this manuscript.
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http://infection.thelancet.com Vol 8 February 2008