Abdominal lymphadenopathy and multiple splenic micro-abscesses in an immunocompetent child with cat-scratch disease
Abstract number: R2545
Al-Fouzan W., Dhar R., Al-Bannai R., Al-Mutairi B.
Background: Cat-scratch disease (CSD),caused by Bartonella henselae, is a benign, self-limiting disease in immunocompetent children with history of contact with cats. The organism is commonly found in the blood of cats and other felids. Classic presentation is tender and swollen regional lymph nodes with or without a papule at the site of initial infection. In immunocompromised patients, however, more severe forms of presentation can occur. Diagnosis is usually possible by serology and or histopathology.
Case summary: An 14-year-old Kuwaiti girl, previously healthy, was admitted with fever, abdominal pain, nausea and generalized weakness. She had arrived from a trip to Egypt five days earlier. There was no history of diarrhea, vomiting, urinary symptoms or rash. On Examination the patient looked ill & had an oral temperature of 40 °C with abdominal tenderness and guarding. Initial blood investigations showed a WBC of 14.1×109, ESR 44 mm/h, C-Reactive Protein (CRP) 150 mg/l, urea 3.2 mmol/l and creatinine 39 umol/l. Urinalysis showed presence of RBC & WBC but the culture was negative. A diagnosis of appendicitis was made and appendicectomy was performed. The patient, however, continued to run high grade fever (>40°C). Therapy with piperacillin-tazobactam (TAZ) and metronidazole was initiated but no clinical response was observed. CT of the abdomen showed mesenteric and para-aortic lymphadenopathy and multiple splenic lesions. A suspicion of enteric fever prompted changing TAZ to ceftriaxone. Blood culture, brucella agglutination, T spot test, & Widal test were all negative. several antibiotic courses including anti-TB & anti-fungal were tried but none helped to improve her condition. Finally, splenectomy and lymph node biopsy was done and the pathology report concluded multiple splenic granulomas with a picture suggestive of CSD. Serology, however, proved negative (IFA titre: IgG: <1:64; IgM: <1:20). History of contact with cats in Egypt was elicited from the patient after pathology report was available. There was a dramatic improvement in her condition following splenectomy.
Conclusion: To the best of our knowledge this is the first case of CSD being reported from Kuwait. We recommend to consider CSD in the differential diagnosis in children presenting with PUO, lymphadenopathy and splenic involvement. Despite several antibiotic courses, which included those recommended in CSD our patient showed defervescence only after splenectomy was performed.
|Session name:||Abstracts of 21st ECCMID / 27th ICC|
|Location:||Milan, Italy, 7 - 10 May 2011|
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