Background Cat-scratch disease (CSD) is an infectious disease typically characterized by a self-limited regional lymphadenopathy. However, CSD can include hepatic and splenic involvement. There are few data in the literature regarding treatment of this situation, although administration of rifampicin associated with gentamicin and doxycycline or azithromycin is promoted.
Case Report A 12 year old girl was admitted because of 3 weeks sustained fever. No remarkable physical findings were presents. Laboratory findings in this admission only show CRP and ESR elevation and positive IgM for cytomegalovirus (CMV), together with fever defervescence, so she was discharged with probable diagnosis of acute CMV infection. However, she was readmitted a week later for recurrence of fever. Abdominal ultrasound detected multiples hyperechoic hepatic lesions and two larger splenic lesions, with no abnormalities of liver function. IgM (1/192) and IgG (1/3200) were positive for Bartonella henselae and PCR to CMV was negative, getting the diagnosis of an hepatosplenic form of CSD. Treatment with rifampicin and trimetroprim during 14 days was unsuccessful, therefore, triple therapy with rifampicin, doxycycline and azithromycin was started. Fever stopped after 6 days of treatment, but reemerged a week later, with a rebound of CRP and ESR levels. Finally, fever and analytical anomalies disappeared after several weeks, under monotherapy with azithromycin. No immunodefienciency was found.
Comments CSD must be suspected in the presence of prolonged fever with or without hepatosplenic involvement. In this case, little response was observed to the antibiotic therapy suggested in the literature, and evolution appeared to be self-limited.