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448 Exuberant Bilateral Inguinal Lymphadenopathies: Less Typical Manifestation of Cat Scratch Disease
  1. C Patraquim1,
  2. MI Alves1,
  3. A Antunes1,
  4. T Pontes1,
  5. S Martins1,
  6. H Antunes1,2
  1. 1Hospital de Braga, Braga
  2. 2Instituto de Ciências da Vida e da Saúde (ICVS), Escola de Ciências da Saúde da Universidade do Minho, Laboratório Associado ICVS/3B’s, Braga/Guimarães, Portugal

Abstract

Introduction Cat scratch disease(CSD) is caused by Bartonella henselae(BH). Regional lymphadenopathy, located to the neck and/or axilla, is the hallmark of CSD.

Case Description A 17-year-old girl presented with a painful right inguinal swelling for the past 3 weeks. Cited contact with small cats. Presented objectively bilateral inguinal lymph node swelling of hard-elastic consistency, 2cm diameter each, barely mobile, with overlying cutaneous inflammatory signs. There were no other palpable lymph nodes, hepatosplenomegaly, lower limbs’ abrasions, or perineal abnormalities. C-reactive protein: 43.40mg/L(N:<2.9mg/L). Inguinal ultrasound suggested cellulite with reactive adenitis. The hypothesis of bacterial abscess or BH infection were most probable, however, other diagnoses were considered such as sexually transmitted disease, tuberculosis lymphadenitis or, eventually, lymphoma.

She was hospitalized with (i.v.)intravenous flucloxacillin. Abdominopelvic ultrasound, chest radiograph, and infectious serologies were normal. BH serology remained in progress during hospitalization. Elevation of erythrocyte sedimention rate (75mm/h). Tuberculin test was negative.

CSD was believed to be the most probable diagnosis, despite the aspect and location of lymphadenopathies, and i.v. clarithromycin was iniciated. Aspirative punction of the enlarged inguinal lymph nodes was performed, exteriorizing a purulent material. BH serology for IgM and IgG was positive. Cytology showed acute inflammatory process with suppuration, and microbiological test was sterile. Searching for bacterial DNA was positive for BH. A month later, she had right inguinal suppuration, and reduction of the lymph nodes size and tenderness.

Discussion The exuberant bilateral lymphadenopathies in less typical location were important confounding factors that led to complementary exams in an usually benign disease.

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