A pediatric case with peripheral facial nerve palsy caused by a granulomatous lesion associated with cat scratch disease.

BACKGROUND: Cat scratch disease is a common infectious disorder caused by Bartonella henselae that is transmitted primarily by kittens. It typically exhibits a benign and self-limiting course of subacute regional lymphadenopathy and fever lasting two to eight weeks. The most severe complication of cat scratch disease is involvement of the nervous system, such as encephalitis, meningitis, and polyneuritis. Peripheral facial nerve palsy associated with Bartonella infection is rare; few reported pediatric and adult cases exist and the precise pathogenesis is unknown. CASE REPORT: A previously healthy 7-year-old boy presented with fever, cervical lymphadenopathy, and peripheral facial nerve palsy associated with serologically confirmed cat scratch disease. The stapedius muscle reflex was absent on the left side and brain magnetic resonance imaging revealed a mass lesion at the left internal auditory meatus. The patient's symptoms and imaging findings were gradually resolved after the antibiotics and corticosteroids treatment. CONCLUSIONS: The suspected granulomatous lesion was considered to have resulted from the host's immune reaction to Bartonella infection and impaired the facial nerve. This is the first case report providing direct evidence of peripheral facial nerve palsy caused by a suspected granulomatous lesion associated with cat scratch disease and its treatment course.

Prolonged course of hepatic granulomatous disease due to Bartonella henselae infection.

Cat-scratch disease (CSD) is an emerging zoonosis caused by Bartonella henselae. The disease is usually self-limiting and typically presents in about 90% of all cases as a subacute regional lymphadenopathy. We present a case report of an unusual CSD presentation, persistent hepatic granulomatous disease due to Bartonella henselae infection despite combination therapy with doxycycline and rifampicin. Furthermore, a review of literature was conducted. (Acta gastroenterol. belg., 2016, 79, 497-499).

Macular findings on optical coherence tomography in cat-scratch disease neuroretinitis.

PURPOSE: To describe the macular findings on optical coherence tomography (OCT) in patients with cat-scratch disease (CSD) neuroretinitis. METHODS: Medical records of all patients diagnosed with CSD neuroretinitis at the Tel Aviv Medical Center between April 2006 and May 2010 were retrospectively reviewed. All patients underwent Stratus OCT macular examination. RESULTS: Eight eyes of seven patients with confirmed CSD neuroretinitis, (mean age 33 ± 9.9 years, range 6-48 years) were included in the study. All patients presented clinically with optic nerve swelling and macular edema or macular exudates. OCT demonstrated flattening of the foveal contour, thickening of the neurosensory retina, and accumulation of subretinal fluid (SRF) in all studied eyes. Retinal exudates appeared as multiple hyper-reflective foci in the outer plexiform layer. The average central macular thickness was 460 µm (range 170-906 µm) and the average maximal retinal thickness was 613 µm (range 387-1103 µm), at presentation. The macula appeared normal on repeated exams during follow-up. CONCLUSION: Similar OCT findings were demonstrated in patients with CSD neuroretinitis. SRF was found in all eyes, although was not visible on clinical examination or fluorescein angiography. OCT may be used as an adjunct imaging tool in the diagnosis and follow-up of patients with CSD neuroretinitis.

[Cat scratch disease: a diagnosis to be aware of!]. / Maladie des griffes du chat: un diagnostic a ne pas méconnaître!

Subacute cervical lymphadenopathy among young adults may be of an infectious or malignant aetiology. We report two cases of young males with chronic cervical lymphadenopathy. A diagnosis of Cat scratch disease (CSD) was made by serological and molecular studies. CSD is one of the most frequent infectious lymphadenopathies among young people. Diagnosis of CSD is dependent on clinical, epidemiological, molecular and histological criteria. The detection of antibodies to Bartonella Henselae and the amplification of its DNA by Polymerase Chain Reaction (PCR) are the two main methods of laboratory diagnosis. The evolution of CSD is usually benign; however therapeutic management remains problematic, particularly in atypical forms.

Visceral involvement in an immunocompetent male: a rare presentation of cat scratch disease.

We report a case of an adult, immunocompetent male with lymphadenopathy of both groins, para-aortal lymph nodes and multiple lesions in the spleen. A neoplasm was excluded by histology of the largest lymph node from the left groin. The diagnosis of cat-scratch disease (CSD ) became apparent when serological testing for Bartonella henselae showed to be positive. A review of literature shows that disseminated (visceral) infection is a rare presentation of CSD.

Development of IgA nephritis following cat scratch disease in a 13-year-old boy.

We describe a 13-year-old boy who presented with hematuria and intermittent low-grade proteinuria at the time when he was diagnosed with cat scratch disease. Two months before presentation, he had a negative urinalysis during a routine physical evaluation. He continued to have microscopic hematuria for the next 6 months, when he developed gross hematuria and recurrence of low-grade proteinuria. The renal biopsy showed evidence of mild/moderate IgA nephropathy. We speculate that the immunological changes associated with cat scratch disease in this patient may have triggered the development of IgA nephropathy. A history or serological evidence of infection with Bartonella henselae may need to be sought in patients presenting with IgA nephritis.

Isolated splenic cat scratch disease in an immunocompetent adult woman.

We report a case of isolated splenic cat scratch disease in an immunocompetent woman. The clinical presentation of prolonged fever, night sweats, weakness, and intrasplenic lesions was highly suggestive of lymphoma. This is the second reported case of isolated splenic cat scratch disease in an adult and the first in a healthy adult.

Bartonella henselae infection mimicking a splenic lymphoma.

We report a Bartonella henselae infection in a 40-y-old patient who presented with fever, weight loss, night sweats, elevated lactate dehydrogenase and multinodular splenomegaly with multiple abdominal lymphadenopathies. Splenic cat-scratch disease is an exceptional diagnosis in adults and can easily be mistaken for a splenic lymphoma, thereby leading to an unnecessary splenectomy.

[Familial parinaud oculo-glandular syndrome in cat-scratch disease].

Cat-scratch disease is manifested by subacute, regional lymphadenitis and occurs mainly in children. The causative agent is a pleomorphic, gram-negative bacillus, Bartonella henselae carried by asymptomatic cats. Parinaud oculoglandular syndrome is the most common ocular manifestation of this disease. It is characterized by unilateral conjunctivitis with polypoid granuloma, usually of the palpebral conjunctiva, and preauricular lymphadenopathy. The diagnosis is supported by a history of exposure to cats and is confirmed by positive serologic tests or positive PCR assay. The occurrence of more than 1 case of Parinaud syndrome in a family is rare. We describe 2 sisters with Parinaud oculoglandular syndrome, proven by serologic tests. They reported that they used to cuddle with their cats, among them a kitten. Because of the refractory conjunctivitis and signs of imminent periorbital cellulitis, they were treated with oral tetracycline with apparently good responses. We recommend asking about contacts with cats in any atypical conjunctivitis accompanied by regional lymphadenopathy, especially in young patients. Systemic antibiotics should be given when there is any suspicion of significant ocular involvement, if the patient is immunosuppressed, or if there are systemic manifestations of cat-scratch disease.

[Bartonellosis: I. Bartonella henselae]. / Les bartonelloses: I. Bartonella henselae.

The recent discovery of the bacterium Bartonella henselae was mainly due to the development of molecular biology techniques adapted to microbial diagnosis and to the description of new human diseases linked to Aids. About 10% of pet cats and 33% of stray cats harbour that bacterium in their blood. In immunocompetent patients, that bacterium is responsible for human cat scratch disease, characterized essentially by a localized lymph nodes enlargement in the vicinity of the entry site of the bacteria. This disease occurs more likely in pet cats less than 1-year-old and infested with fleas. The bacterium is transmitted to humans by scratches or bites; the role of fleas is possible, but is not yet documented. In 5 to 13% of cases, the cat scratch disease appears as more severe, including health impairment, hepatitis, Parinaud's oculo-glandular syndrome, neurological complications or stellate retinitis. In immunocompromised patients, B. henselae is responsible for various clinical presentations: bacillary angiomatosis, bacillary peliosis, recurrent or persistent bacteremia or endocarditis. Diagnosis of infections due to B. henselae can be performed by serological specific testing with sensitivity and specificity values ranging from 75 to 100%. Cultivation of the bacterium is fastidious, particularly in cases of cat scratch disease. The most efficient diagnostic test is the in vitro DNA amplification which has the drawback to require a lymph node sample. Antibiotics are usually inefficient for the treatment of cat scratch disease. By contrast, in immunocompromised patients, these infections are successfully treated for a more or less long time by macrolides or tetracyclines or rifampin.

Chest-wall abscess due to cat-scratch disease (CSD) in an adult with antibodies to Bartonella clarridgeiae: case report and review of the thoracopulmonary manifestations of CSD.

We describe a patient who presented with a massive chest-wall abscess after a severe debilitating illness that lasted 3 months. Steroid therapy, administered for 4 weeks, masked the slow development of an extensive axillary and chest-wall abscess. After multiple negative tests, the patient's prolonged illness was diagnosed as cat-scratch disease (CSD). An indirect fluorescent antibody test revealed that two convalescent serum samples were positive for IgG to Bartonella clarridgeiae, but no other Bartonella species. We also review 12 cases of severe chest and pulmonary disease due to CSD that were reported in the English-language literature. Thoracopulmonary findings associated with CSD, pathogenic mechanisms of bartonella infections, diagnostic criteria, and management of CSD are presented.

Doença da arranhadura do gato: relato de caso atípico / Cat-scratch disease: atypical case

Descriçäo de um caso de doença de arranhadura de gato (D.A.G.) ou linforreticulose benigna de inoculaçäo. Seu agente etiológico é a Bartonella henselae (previamente denominada Rochalimaea henselae), um bacilo gram-negativo pleomórfico de pequenas dimensöes, membro do subgrupo Ó-2 das Ó-proteobactérias. Esta doença é a principal causa da Síndrome Oculoglandular de Parinaud, uma conjuntivite granulomatosa com adenopatia regional, que representa uma forma atípica de doença (6 por cento dos casos de D.A.G.)

Hypercalcemia due to endogenous overproduction of active vitamin D in identical twins with cat-scratch disease.

CONTEXT: The extrarenal synthesis of active vitamin D sterols has a central causative role in the hypercalcemia associated with various granulomatous diseases. OBJECTIVE: To study the calcium metabolism in patients with cat-scratch disease who have hypercalcemia. DESIGN: Case report. SETTING: University hospital in Barcelona, Spain. PATIENTS: Two identical twins who developed asymptomatic hypercalcemia during the acute phase of cat-scratch disease. MAIN OUTCOME MEASURES: Serial measures of calcium homeostasis and metabolism over a 2-month period. RESULTS: On admission and 6 and 7 days later, both patients were found to have increased levels of serum and urinary calcium, serum phosphate, and serum 1,25-dihydroxyvitamin D [1,25(OH)2D], whereas they had normal values of serum 25-hydroxyvitamin D and urinary cyclic adenosine monophosphate and decreased serum concentrations of intact parathyroid hormone. Sixteen and 20 days after admission, these abnormalities had resolved without treatment. A direct correlation was observed between the serum 1,25(OH)2D levels and both the serum and 24-hour urinary calcium concentrations. Also, the concentrations of calcium and 1,25(OH)2D paralleled the clinical activity of the infectious disease over the period these parameters were measured. CONCLUSIONS: Our cases provide evidence that cat-scratch disease can produce hypercalcemia through the unregulated production of the metabolite 1,25(OH)2D. Cat-scratch disease should be added to the list of granuloma-forming diseases that are responsible for 1,25(OH)2D-mediated hypercalcemia.

[Cat-scratch disease as a diagnostic problem of lymphadenopathy]. / Choroba kociego pazura--trudnosci diagnostyczne.

The diagnosis of cat-scratch disease is based on history and clinical symptoms. We present a case of a 4-year-old girl admitted to our unit with suspicion of histiocytosis X after histologic evaluation of a submandibular lymph node biopsy. On the basis of history, clinical features and histologic reevaluation, the diagnosis of cat-scratch disease was made.

[Cat-scratch disease presenting as a pseudotumor. Imaging by x-ray computed tomography and MRI]. / Maladie des griffes du chat de présentation pseudotumorale. Aspect en scanographie et en IRM.

Cat-scratch disease is usually a self-limiting illness but it can initially present as a tumor. A case of a lesion of the arm is described, with CT and MR findings. The radiologic appearance is not characteristic but the diagnosis can be suggested in a predisposing clinical setting.