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Dhal U, Hicklen RS, Tarrand J, Kontoyiannis DP. Cat Scratch Disease as a Mimicker of Malignancy. Open Forum Infect Dis 2021; 8:ofab500. [PMID: 34926712 PMCID: PMC8675392 DOI: 10.1093/ofid/ofab500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Cat scratch disease (CSD) infrequently mimics malignancy. We reviewed 11 such
cases at MD Anderson Cancer Center and an additional 36 reported from the
literature. Breast cancer, sarcoma, and lymphoma were the most commonly
suspected malignancies. Most patients were young, female, had prior cat
exposure, and had no systemic symptoms. Regional lymphadenopathy was the most
common finding.
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Affiliation(s)
- Udit Dhal
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
- Department of Infectious Diseases, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rachel S Hicklen
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey Tarrand
- Section of Clinical Microbiology and Virology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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2
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Salmon-Rousseau A, Auvray C, Besset Q, Briandet C, Desplantes C, Chavanet P. Costal osteomyelitis due to Bartonella henselae in a 10-year-old girl. J Bone Jt Infect 2021; 6:171-178. [PMID: 34109101 PMCID: PMC8182667 DOI: 10.5194/jbji-6-171-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Bartonella henselae
is the bacterial agent responsible for cat scratch
disease. This infection is frequently the cause of localized lymphadenitis in
children. It is also sometimes responsible for endocarditis, encephalitis, hepatic
peliosis and in rare cases osteomyelitis. We describe the second known case of unifocal thoracic
osteomyelitis in a
10-year-old child.
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Affiliation(s)
| | - Christelle Auvray
- Laboratory of Virology, François Mitterrand University Hospital, Dijon, France
| | - Quentin Besset
- Infectious Diseases Department, Dijon University Hospital, Dijon, France
| | - Claire Briandet
- Department of Pediatric Onco-Hematology, Dijon University Hospital, Dijon, France
| | - Claire Desplantes
- Department of Pediatric Onco-Hematology, Dijon University Hospital, Dijon, France
| | - Pascal Chavanet
- Infectious Diseases Department, Dijon University Hospital, Dijon, France
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3
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Abstract
Bartonella henselae, the causative agent of cat scratch disease (CSD), is one of the most common causes of regional lymphadenitis in children. Other less common manifestations of B. henselae infection including fever of unknown origin, neuroretinitis, and osteomyelitis are being increasingly recognized. We describe a 3-year-old female with a recent history of typical CSD involving lymph nodes who developed osteomyelitis of the skull, a very rarely recognized complication of this infection.
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Affiliation(s)
- Yaseen Rafee
- Department of Pediatrics, Division of Infectious Disease, Hurley Children's Hospital, Flint, MI, USA.,Department of Pediatrics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - B Keith English
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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4
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Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma-A Case Report and Literature Review. Case Rep Pediatr 2018; 2018:1679306. [PMID: 29808150 PMCID: PMC5902065 DOI: 10.1155/2018/1679306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 12/20/2022] Open
Abstract
Background We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old female with skull osteomyelitis and spleen involvement. Methods A search for articles indexed in PubMed, Embase, and Google Scholar was performed with the search terms "Bartonella," "bone," "osteomyelitis," "osteolytic," and "cat-scratch disease" limited to the immunocompetent pediatric population and articles in English. Results 51 cases were identified. The average age was 7.8 years with equal sex distribution. Fever (84.3%), often with a prolonged course (64.7%), and osteoarticular pain (88.2%) were the most common clinical findings. Lymphadenopathy was present in 64.7% of patients. Vertebral body was mainly involved (51.9%). MRI (50%) and bone scintigraphy (48.1%) were favored to confirm osteomyelitis, while serology was the preferred microbiological diagnostic. Various antibiotics were prescribed in combined or sequential regimens, with median duration of therapy of 23 days. About 12.5% of patients did not receive any treatment. Most patients had excellent prognosis; in particular, all patients not receiving any therapy showed complete recovery and no recurrence of symptoms. Conclusions Bartonella henselae should be considered in differential diagnosis of localized lymphadentitis. Osteoarticular pain or limitation during cat-scratch disease in children should always be investigated for bone spreading. Owing to good prognosis, invasive procedures to obtain the bone material should be avoided. Serology is the gold standard diagnostic tool and MRI is the best radiographic technique to define bone and surrounding tissue involvement. Treatment represents a never-ending dilemma: surgical intervention or use of antibiotics is still controversial, and more studies are needed to define the best antimicrobial regimen.
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Joychan S, Kuchipudi Y, Danielsky PJ, Bovid KM, Garg D. Case of Nonspinal Osteomyelitis Due to Bartonella and Review of the Literature. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mazur-Melewska K, Jończyk-Potoczna K, Mania A, Kemnitz P, Szydłowski J, Służewski W, Figlerowicz M. The significance of Bartonella henselae bacterias for oncological diagnosis in children. Infect Agent Cancer 2015; 10:30. [PMID: 26379764 PMCID: PMC4568588 DOI: 10.1186/s13027-015-0025-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/19/2015] [Indexed: 12/30/2022] Open
Abstract
Background Cat-scratch disease (CSD) is a common infection in children; however, the wide spectrum of its clinical picture may lead to delayed diagnosis. An unusual presentation of CSD includes in the differential diagnosis malignant diseases, Epstein-Barr and cytomegalovirus infections, tuberculosis, and mycobacterioses. The diagnostic procedure is difficult, and it is important to consider CSD as the etiology of untypical lesion. Patients and method We present the analysis of 22 immunocompetent children treated with the clinical diagnosis of CSD in our hospital. Their ages were 2 to 16 years (mean 9.15 ± 2.2 years). Four of them presented classical papulas at admission time. Asymmetric, local lymphadenopathy was present in 16 patients. Five children, who presented an untypical course of CSD mimicking the oncological process, were analysed carefully. There were 3 patients with skull osteomyelitis, 1 with inflammation of the parotid gland, and 1 with an extra peripharyngeal mass. The diagnosis in these children was based on epidemiological, radiological, serological, and histological factors. Results About 25 % of children with bartonellosis present an untypical spectrum of symptoms, including the lack of documented cat contact, primary lesions, or peripheral lymphadenopathy. Radiological methods like USG, CT, MRI present the unspecific masses, but they are not enough to distinguish the Bartonella inflammatory and oncological process. The final diagnosis was based on a histological method with additional polymerase chain reaction test. Conclusion CSD should be considered in differential diagnosis of any patient with untypical lesions located on the head, neck, and upper extremities.
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Affiliation(s)
- Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology Karol Marcinkowski University of Medical Sciences, Szpitalna Street 27/33, 60-578 Poznań, Poland
| | - Katarzyna Jończyk-Potoczna
- Pediatric Radiology Department Chair of Radiology Karol Marcinkowski University of Medical Sciences, Szpitalna Street 27/33, 60-578 Poznań, Poland
| | - Anna Mania
- Department of Infectious Diseases and Child Neurology Karol Marcinkowski University of Medical Sciences, Szpitalna Street 27/33, 60-578 Poznań, Poland
| | - Paweł Kemnitz
- Department of Infectious Diseases and Child Neurology Karol Marcinkowski University of Medical Sciences, Szpitalna Street 27/33, 60-578 Poznań, Poland
| | - Jarosław Szydłowski
- Pediatric ENT Department, Karol Marcinkowski Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-578 Poznań, Poland
| | - Wojciech Służewski
- Department of Infectious Diseases and Child Neurology Karol Marcinkowski University of Medical Sciences, Szpitalna Street 27/33, 60-578 Poznań, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology Karol Marcinkowski University of Medical Sciences, Szpitalna Street 27/33, 60-578 Poznań, Poland
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Fretzayas A, Tapratzi P, Kavazarakis E, Sinaniotis C. Multiorgan Involvement in Systemic Cat-Scratch Disease. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/00365549309169684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Roubaud-Baudron C, Fortineau N, Goujard C, Le Bras P, Lambotte O. Maladie des griffes du chat avec localisations osseuses : une observation et revue de la littérature. Rev Med Interne 2009; 30:602-8. [DOI: 10.1016/j.revmed.2009.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 01/03/2009] [Accepted: 01/31/2009] [Indexed: 11/28/2022]
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Hajjaji N, Hocqueloux L, Kerdraon R, Bret L. Bone infection in cat-scratch disease: A review of the literature. J Infect 2007; 54:417-21. [PMID: 17140668 DOI: 10.1016/j.jinf.2006.10.045] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 10/16/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the main features of bone infection associated with Cat-scratch disease (CSD). METHODS We searched for articles indexed in the international literature databases by using the following key words: "Bartonella", "bone", "cat-scratch", "osteomyelitis" and "osteolytic". RESULTS Cases of 47 patients were reviewed. The median age was 9 years, with an equal sex distribution. Bone pain and fever were the main symptoms. The presence of fever and increased age were more common in patients with bone infection than classically reported in uncomplicated (i.e. nodal) CSD. The vertebral column and pelvic girdle were the most common sites of infection. Radiological examination typically confirmed bone osteolysis. All patients recovered without complications or chronic infection, although they received a various combination antibiotic regimen and duration therapy. The mechanism by which infection might spread to the bone is via the haematogenous route, accounting for most of the disseminated cases and via the lymphatic route, for those with regional limited extension. CONCLUSIONS Bone infection is rare but should be considered when bone pain and fever are present in a patient with nodal CSD. The prognosis is good, whatever treatment is given. Thus bone biopsy should be recommended only in a difficult diagnostic setting, when other bacteria or malignant disease are suspected.
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Affiliation(s)
- Nawale Hajjaji
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional-La Source, BP 86709, 45067 Orléans Cedex 2, France
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Abdel-Haq N, Abuhammour W, Al-Tatari H, Asmar B. Disseminated cat scratch disease with vertebral osteomyelitis and epidural abscess. South Med J 2006; 98:1142-5. [PMID: 16351038 DOI: 10.1097/01.smj.0000163305.50078.63] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 5-year-old boy with cat scratch disease presented with fever of unknown origin and osteomyelitis of the thoracic spine and epidural abscess. He did not have localizing signs or symptoms. Computed tomography of the abdomen, which was initially negative, showed hepatosplenic disease. Cat scratch disease has variable systemic presentations and should be included in the differential diagnosis of fever of unknown origin if an epidemiologic risk factor is present.
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Affiliation(s)
- Nahed Abdel-Haq
- Children's Hospital of Michigan, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
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11
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Hipp SJ, O'Shields A, Fordham LA, Blatt J, Hamrick HJ, Henderson FW. Multifocal bone marrow involvement in cat-scratch disease. Pediatr Infect Dis J 2005; 24:472-4. [PMID: 15876956 DOI: 10.1097/01.inf.0000160993.52059.3a] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe 2 children with prolonged fever of unknown origin and prominent skeletal pain who had multifocal bone disease caused by Bartonella infection. Initial radiologic studies, including plain films, radionuclide scintigraphy and computed tomography, yielded negative results. In both cases, magnetic resonance imaging revealed multiple enhancing bone marrow lesions consistent with clinical symptoms. Microbiologic diagnoses were established serologically.
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Affiliation(s)
- Sean J Hipp
- Departments of Pediatrics, University of North Carolina, Chapel Hill, NC 27599-7593, USA.
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Dzelalija B, Petrovec M, Avsic-Zupanc T. Probable atypical cat scratch disease presenting as isolated posterior pancreatic duodenal lymphadenitis and abdominal pain. Clin Infect Dis 2001; 33:912-4. [PMID: 11512100 DOI: 10.1086/322692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2001] [Revised: 04/03/2001] [Indexed: 11/03/2022] Open
Abstract
We report a case involving a 15-year-old girl with atypical, clinically unsuspected cat scratch disease (CSD) presenting as isolated posterior pancreatic duodenal lymphadenitis, fever, and abdominal pain. The serological, abdominal ultrasonographic, and CT findings, as well as clinical and epidemiological data, indicate that B. henselae was likely an etiologic agent of CSD in our patient.
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Affiliation(s)
- B Dzelalija
- Department of Infectious Diseases, General Hospital Zadar, Zadar, Croatia.
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Karem KL, Paddock CD, Regnery RL. Bartonella henselae, B. quintana, and B. bacilliformis: historical pathogens of emerging significance. Microbes Infect 2000; 2:1193-205. [PMID: 11008109 DOI: 10.1016/s1286-4579(00)01273-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Bartonella species were virtually unrecognized as modern pathogens of humans until the last decade. However, identification of Bartonella species as the agents of cat-scratch disease, bacillary angiomatosis, urban trench fever, and possible novel presentations of Carrion's disease has left little doubt of the emerging medical importance of this genus of organisms. The three primary human pathogenic bartonellae, Bartonella bacilliformis (Carrion's disease), B. henselae (cat-scratch disease), and B. quintana (trench fever), present noteworthy comparisons in the epidemiology, natural history, pathology, and host-microbe interaction that this review will briefly explore.
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Affiliation(s)
- K L Karem
- Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia 30333, USA
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14
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Abstract
Cat-scratch disease is a self-limited condition commonly causing a benign chronic lymphadenopathy in children. Osteolytic lesions are a rare complication, but have been previously reported. We report a case of a solitary osteolytic lesion of the skull whose clinical, radiographic and pathological features were initially interpreted as being consistent with Histiocytosis X. Subsequently, positive serological titers for Bartonella, a history of a cat-scratch antecedent to the onset of clinical symptoms and review of the original histopathology confirmed the diagnosis of cat-scratch disease. We reviewed the English language literature on osteolytic lesions associated with cat-scratch disease and compare the current case with those previously reported.
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Affiliation(s)
- L C Berg
- Department of Pathology, Gunderson Clinic, Ltd, LaCrosse, WI 45601, USA
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15
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Abstract
Members of the genus Bartonella (formerly Rochalimaea) were virtually unknown to modern-day clinicians and microbiologists until they were associated with opportunistic infections in AIDS patients about 6 years ago. Since that time, Bartonella species have been associated with cat scratch disease, bacillary angiomatosis, and a variety of other disease syndromes. Clinical presentation of infection with Bartonella ranges from a relatively mild lymphadenopathy with few other symptoms, seen in cat scratch disease, to life-threatening systemic disease in the immunocompromised patient. In some individuals, infection manifests as lesions that exhibit proliferation of endothelial cells and neovascularization, a pathogenic process unique to this genus of bacteria. As the spectrum of disease attributed to Bartonella is further defined, the need for reliable laboratory methods to diagnose infections caused by these unique organisms also increases. A brief summary of the clinical presentations associated with Bartonella infections is presented, and the current status of laboratory diagnosis and identification of these organisms is reviewed.
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Affiliation(s)
- B E Anderson
- Department of Medical Microbiology and Immunology, College of Medicine, University of South Florida, Tampa 33612, USA.
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17
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Abstract
OBJECTIVE To present a perspective on the current state of knowledge of cat scratch disease (CSD), including the evidence for Bartonella henselae as the etiological agent, epidemiological and clinical characteristics of the disease, available diagnostic tests and current therapeutic options. DATA SOURCES MEDLINE search of the literature published from 1966 to 1995 using 'cat scratch disease', 'Bartonella henselae', 'Rochalimaea henselae' as key words and bibliographies of selected papers. DATA EXTRACTION Selected studies reporting data on etiology, epidemiology, clinical characteristics, diagnosis and therapy of CSD were evaluated. DATA SYNTHESIS AND CONCLUSIONS Evidence accumulated to date supports B henselae as the etiological agent of CSD. The most significant risk factors for CSD are being licked on the face, scratched or bitten by a kitten and owning a kitten with fleas. Available serological tests can confirm classic CSD and identify B henselae as the cause of more atypical presentations, such as fever of unknown origin, granulomatous hepatitis, encephalitis and osteomyelitis. Symptomatic management is appropriate for isolated lymphadenopathy caused by CSD in healthy individuals; however, antibiotic therapy may be indicated for patients with more severe manifestations of the disease and immunocompromised hosts. Further study of CSD, in particular the epidemiology and therapy, is warranted. A better understanding of the pathogenesis of B henselae infection will have important implications in both immunocompetent and immunocompromised individuals.
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Affiliation(s)
- M A Opavsky
- Winner of the Canadian Infectious Disease Society/Canadian Journal of Infectious Diseases Review Article Award; portions of this review have also been submitted as part of a Canadian Paediatric Society statement on cat scratch disease, The Hospital for Sick Children, Toronto, Ontario
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Wilson JD, Castillo M. Cat-scratch disease. Subtle vertebral bone marrow abnormalities demonstrated by MR imaging and radionuclide bone scan. Clin Imaging 1995; 19:106-8. [PMID: 7773872 DOI: 10.1016/0899-7071(94)00035-b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cat-scratch disease (CSD) is a benign, self-limited cause of lymphadenitis occurring mainly in children and young adults. Its etiology is a delicate, small gram-negative pleomorphic bacillus. Less common manifestations of CSD are seen in 5% of patients and include Parinaud's oculoglandular syndrome (with enlargement of the preauricular nodes), parotid gland enlargement, encephalitis, radiculopathy, pneumonitis, erythema nodosum, thrombocytopenia, and lytic bone lesions. We describe a patient in whom magnetic resonance imaging initially detected subtle vertebral bone marrow abnormalities that correlated with the site of abnormality on a subsequent radionuclide bone scan.
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Affiliation(s)
- J D Wilson
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599-7510, USA
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19
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Bernini PM, Gorczyca JT, Modlin JF. Cat-scratch disease presenting as a paravertebral abscess. A case report. J Bone Joint Surg Am 1994; 76:1858-63. [PMID: 7989392 DOI: 10.2106/00004623-199412000-00014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- P M Bernini
- Section of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756
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20
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Abstract
Cat scratch disease is usually a self-limiting illness. Patients may develop systemic complications including hepatic granulomas, splenic abscesses, mesenteric adenitis, osteolytic lesions, as well as dermatologic and CNS complications. In this paper the literature is reviewed and two cases are discussed which present the imaging findings in patients with hepatic, splenic, mesenteric, and bony manifestations of cat scratch disease.
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Affiliation(s)
- C E Larsen
- Department of Radiology, Egleston Children's Hospital, Emory University, Atlanta, Georgia
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21
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Arlet G, Perol-Vauchez Y. The current status of cat-scratch disease: an update. Comp Immunol Microbiol Infect Dis 1991; 14:223-8. [PMID: 1959317 DOI: 10.1016/0147-9571(91)90002-u] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cat-scratch disease (CSD) is a benign inoculative lymphoreticulosis, first described in independent reports by Pierre Mollaret [1] and Robert Debre in 1950 [2]. The disease usually self-limited, with spontaneous resolution occurring after several weeks, appears to be related to the presence of an identified gram-negative bacteria.
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Affiliation(s)
- G Arlet
- Service de Bactériologie-Virologie, Hôpital Saint-Louis, Paris, France
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