Expressive aphasia as a presentation of encephalitis with Bartonella henselae infection in an immunocompetent adult.

ABSTRACT

OBJECTIVE: To show the first clinically reported case of Cat Scratch Disease (CSD) presenting as a focal neurologic deficit in an immunocompetent adult. PATIENT 59-year-old male with a history of a previous stroke. RESULTS: Examination showed an expressive aphasia, word substitution errors, and impaired repetition. A head CT and MRI showed no acute changes. The EEG findings were non-focal and did not show any epileptiform activity. The patient had a history of contact with stray kittens and previous axillary lymphadenopathy. Bartonella henselae serology titers were IgG positive 11024 (< 64) and IgM positive 120 (< 16). After antibiotic administration, the patient's symptoms and aphasia resolved. CONCLUSIONS: Focal presentations concerning for stroke or partial seizure activity may have underlying infectious etiology. We recommend consideration of CSD in the differential diagnosis of any adult with a history of lymphadenopathy, fever, and recent contact with a cat who presents with neurologic complications.