Images in Clinical Medicine

Cat Scratch Disease

Michael Giladi, M.D., and Boaz Avidor, Ph.D.

N Engl J Med 1999; 340:108January 14, 1999

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Figure 1 A 17-year-old boy presented with a two-week history of a painful mass on the right side of the neck, fever, malaise, headache, and night sweats. The fever and other systemic symptoms gradually abated during the first 10 days of his illness, but the cervical mass increased in size. The patient owned a kitten, which often scratched him. On examination, a hard, immobile mass measuring 3.5 by 3 cm that was tender to the touch was palpable (Panel A). Serum enzyme immunoassay was positive for IgG antibodies to Bartonella henselae, and the patient was given a 14-day course of oral ciprofloxacin. Two weeks later, the mass became fluctuant and 6 ml of pus was aspirated (Panel B). Cultures for bacteria (including B. henselae and Afipia felis ), mycobacteria, and fungi were negative. The pus was subjected to a polymerase-chain-reaction assay with primers specific for the B. henselae citrate synthase gene, followed by digestion with TaqI restriction enzyme. The resulting fragments showed the characteristic DNA-band pattern of B. henselae on electrophoresis (Panel C): lanes 2 (1 μl) and 3 (2 μl) show pus specimens from the patient; lanes 1, 5, 7, and 8 show pus specimens from patients without cat scratch disease; lane 4 shows B. henselae DNA; lane 6 shows pus specimens from another patient with cat scratch disease; and lane 9 shows the molecular-size marker. The mass slowly decreased in size during the next seven months, but recurrent aspirations of pus were required. Twelve months after the onset of illness, the patient was asymptomatic, with no palpable neck mass.

Michael Giladi, M.D.
Boaz Avidor, Ph.D.
Tel Aviv Medical Center, Tel Aviv 64239, Israel

Citing Articles (4)

Citing Articles

1. 1

   D. Raoult. (2007) From Cat Scratch Disease to Bartonella henselae Infection. Clinical Infectious Diseases 45:12, 1541-1542
   CrossRef

2. 2

   Robert Krause, Christoph Wenisch, Emil C. Reisinger. (2003) Primary lesion of cat-scratch disease and inguinal cat-scratch disease. Wiener Klinische Wochenschrift 115:3-4, 88-88
   CrossRef

3. 3

   Michael Giladi, Yehudith Kletter, Boaz Avidor, Einat Metzkor‐Cotter, Merav Varon, Yoav Golan, Miriam Weinberg, Irena Riklis, Moshe Ephros, Leonard Slater. (2001) Enzyme Immunoassay for the Diagnosis of Cat‐Scratch Disease Defined by Polymerase Chain Reaction. Clinical Infectious Diseases 33:11, 1852-1858
   CrossRef

4. 4

   (1999) Treatment of Cat Scratch Disease. New England Journal of Medicine 340:23, 1842-1843
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