[Rash and purulent lymphadenitis in cat scratch disease]. / Osip i purulentni limfadenitis u bolesti macjeg ogreba.

ABSTRACT

We present a case of a cat-scratch disease (CSD) presenting with typical (primary lesion and regional lymphadenitis) and rare (purulent lymphadenitis and maculopapular rash) symptoms and positive epidemiological data. Laboratory blood test showed normal values for routine parameters, except for mild leukocytosis (L 12.4 x 10(9)), elevated erythrocyte sedimentation rate (SE 65/h) and moderately elevated asparta e-aminotransferase and alanine-aminotransferase values (AST/ALT 48/90), fibrinogen (5.3 g/L) and C-reactive protein (CRP 85 mg/L). Cytological analysis of lymph node content revealed granulomatous inflammation in the first sample, and purulent inflammation in the second sample. In paired serum samples, collected on the 15th and 29th day from the onset of disease, antibodies IgG (titre 4096/8192) and IgM (titre 80/40) to Bartonella henselae were detected by using an indirect immunofluorescence assay (IFA). Antibiotic therapy with azithromycin (1 x 500 mg per os/5 days) was administered. Purulent lymphadenitis and rash, although a rare clinical manifestation in CSD, are significant clinical findings in differentiating CSD from other febrile illnesses accompanied with rash and lymphadenitis.