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Atypical presentation of cat-scratch disease in an immunocompetent child with serological and pathological evidence.

Atıcı S, Kadayıfcı EK, Karaaslan A, Toper MH, Celikel CA, Soysal A, Bakır M - Case Rep Pediatr (2014)

Bottom Line: Herein we present a case of systemic CSD presenting with hepatic mass in an immunocompetent child.The differential diagnosis is made by serological and pathological evidence.He was successfully treated with gentamicin (7.5 mg/kg) and rifampin (15 mg/kg) for six weeks.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics and Division of Pediatric Infectious Diseases, Marmara University Medical Faculty, Pendik Training and Research Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad., Ust Kaynarca, Pendik, 34899 Istanbul, Turkey.

ABSTRACT
Typical cat-scratch disease (CSD) is characterized by local lymphadenopathy following the scratch or bite from a cat or kitten. An atypical presentation which includes liver and/or spleen lesions is rarely reported in an immunocompetent child. Systemic CSD may mimic more serious disorders like malignancy or tuberculosis. Although a diagnosis is difficult to establish in systemic CSD, an early diagnosis and an appropriate treatment are important to prevent complications. Bartonella henselae is difficult to culture, and culture is not routinely recommended. Clinical, serological, radiological, and pathological findings are used for the diagnosis of CSD. Herein we present a case of systemic CSD presenting with hepatic mass in an immunocompetent child. The differential diagnosis is made by serological and pathological evidence. He was successfully treated with gentamicin (7.5 mg/kg) and rifampin (15 mg/kg) for six weeks.

No MeSH data available.


Related in: MedlinePlus

(a) The liver lesion is characterized by multiple granulomas hematoxylin and eosin ×10, (b) acid-fast Bacilli was not detected with EZN staining ×10, and (c) Bartonella henselae was demonstrated by Warthin-Starry silver stain ×10.
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fig2: (a) The liver lesion is characterized by multiple granulomas hematoxylin and eosin ×10, (b) acid-fast Bacilli was not detected with EZN staining ×10, and (c) Bartonella henselae was demonstrated by Warthin-Starry silver stain ×10.

Mentions: A 12-year-old boy was admitted to another hospital with 7-day history of fever, abdominal pain, headache, and weight loss. Empirical antibiotics therapy including ceftriaxone and clindamycin had been administered. After the abdominal ultrasound demonstrated multiple hypoechoic liver lesions, he was transferred to our department on the eleventh day of hospitalization. Fever and abdominal pain continued and he had lost 8 kilograms. He had a history of playing with a kitten. Physical examination revealed bilateral inguinal lymphadenopathy. There was not any scratch or papule on his skin. His past medical history was not consistent with any primary or secondary immunodeficiency or any other underlying disease. Laboratory findings included the following: white blood cell count, 10 400/mm3; hemoglobin, 11.9 g/dL; platelets, 385 000/mm3; C-reactive protein (CRP), 10.1 mg/dL; erythrocyte sedimentation rate (ESR), 57 mm in 1 h; aspartate aminotransferase (AST), 168 U/L; alanine aminotransferase (ALT), 67 U/L. Blood and urine cultures were negative. Serology of human immunodeficiency virus was also negative. Abdominal magnetic resonance imaging (MRI) showed multiple hepatic lesions (Figure 1). Cranial and thoracal imaging revealed no distinct abnormality. Serological analyses by indirect fluorescent antibody (IFA) method detected the presence of immunoglobulin (Ig) G and IgM antibodies to Bartonella henselae positive with a titer of 1 : 320 and 1 : 100, respectively. He was assessed to the pediatric immunology department with suspected immunodeficiency. Lymphocyte subset analysis, dihydrorhodamine 123 flow cytometry, and the serum immunoglobulins levels were normal. Ultrasound guided liver biopsy was performed. Histopathological analyses of the lesions showed granulomas surrounded with palisade histiocytes and non calcified necrosis with hematoxylin and eosin (H&E) staining (Figure 2(a)). Acid-fast Bacilli were not detected with Ehrlich-Ziehl-Neelsen (EZN) staining (Figure 2(b)). Warthin-Starry silver stain was positive which was compatible with CSD (Figure 2(c)).


Atypical presentation of cat-scratch disease in an immunocompetent child with serological and pathological evidence.

Atıcı S, Kadayıfcı EK, Karaaslan A, Toper MH, Celikel CA, Soysal A, Bakır M - Case Rep Pediatr (2014)

(a) The liver lesion is characterized by multiple granulomas hematoxylin and eosin ×10, (b) acid-fast Bacilli was not detected with EZN staining ×10, and (c) Bartonella henselae was demonstrated by Warthin-Starry silver stain ×10.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4291153&req=5

fig2: (a) The liver lesion is characterized by multiple granulomas hematoxylin and eosin ×10, (b) acid-fast Bacilli was not detected with EZN staining ×10, and (c) Bartonella henselae was demonstrated by Warthin-Starry silver stain ×10.
Mentions: A 12-year-old boy was admitted to another hospital with 7-day history of fever, abdominal pain, headache, and weight loss. Empirical antibiotics therapy including ceftriaxone and clindamycin had been administered. After the abdominal ultrasound demonstrated multiple hypoechoic liver lesions, he was transferred to our department on the eleventh day of hospitalization. Fever and abdominal pain continued and he had lost 8 kilograms. He had a history of playing with a kitten. Physical examination revealed bilateral inguinal lymphadenopathy. There was not any scratch or papule on his skin. His past medical history was not consistent with any primary or secondary immunodeficiency or any other underlying disease. Laboratory findings included the following: white blood cell count, 10 400/mm3; hemoglobin, 11.9 g/dL; platelets, 385 000/mm3; C-reactive protein (CRP), 10.1 mg/dL; erythrocyte sedimentation rate (ESR), 57 mm in 1 h; aspartate aminotransferase (AST), 168 U/L; alanine aminotransferase (ALT), 67 U/L. Blood and urine cultures were negative. Serology of human immunodeficiency virus was also negative. Abdominal magnetic resonance imaging (MRI) showed multiple hepatic lesions (Figure 1). Cranial and thoracal imaging revealed no distinct abnormality. Serological analyses by indirect fluorescent antibody (IFA) method detected the presence of immunoglobulin (Ig) G and IgM antibodies to Bartonella henselae positive with a titer of 1 : 320 and 1 : 100, respectively. He was assessed to the pediatric immunology department with suspected immunodeficiency. Lymphocyte subset analysis, dihydrorhodamine 123 flow cytometry, and the serum immunoglobulins levels were normal. Ultrasound guided liver biopsy was performed. Histopathological analyses of the lesions showed granulomas surrounded with palisade histiocytes and non calcified necrosis with hematoxylin and eosin (H&E) staining (Figure 2(a)). Acid-fast Bacilli were not detected with Ehrlich-Ziehl-Neelsen (EZN) staining (Figure 2(b)). Warthin-Starry silver stain was positive which was compatible with CSD (Figure 2(c)).

Bottom Line: Herein we present a case of systemic CSD presenting with hepatic mass in an immunocompetent child.The differential diagnosis is made by serological and pathological evidence.He was successfully treated with gentamicin (7.5 mg/kg) and rifampin (15 mg/kg) for six weeks.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics and Division of Pediatric Infectious Diseases, Marmara University Medical Faculty, Pendik Training and Research Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad., Ust Kaynarca, Pendik, 34899 Istanbul, Turkey.

ABSTRACT
Typical cat-scratch disease (CSD) is characterized by local lymphadenopathy following the scratch or bite from a cat or kitten. An atypical presentation which includes liver and/or spleen lesions is rarely reported in an immunocompetent child. Systemic CSD may mimic more serious disorders like malignancy or tuberculosis. Although a diagnosis is difficult to establish in systemic CSD, an early diagnosis and an appropriate treatment are important to prevent complications. Bartonella henselae is difficult to culture, and culture is not routinely recommended. Clinical, serological, radiological, and pathological findings are used for the diagnosis of CSD. Herein we present a case of systemic CSD presenting with hepatic mass in an immunocompetent child. The differential diagnosis is made by serological and pathological evidence. He was successfully treated with gentamicin (7.5 mg/kg) and rifampin (15 mg/kg) for six weeks.

No MeSH data available.


Related in: MedlinePlus