A normally healthy 7-year-old female complained of “not feeling good.” She had no fever, nausea, or diarrhea. She was lethargic but continued to attend school. Her mother took her to their pediatrician. Upon examination, he noted a unilateral lymphadenopathy in her right axilla. The rest of the examination was normal. Lab testing showed mildly elevated liver function tests and a Westergren sedimentation rate of 65 mm/hr. She was then referred to an infectious disease specialist for further evaluation. The answer was found in an in-depth history. She had 3 young cats in her home that she always played with. Although no specific bite or scratch was found, the presumed diagnosis was cat scratch disease (CSD). Caused by the bacterium Bartonella henselae, CSD is typically benign, so no treatment was considered necessary. Though occasional severe side effects are possible, they are rare. Most cases are found in children. Follow-up lab work at 6 weeks showed resolution of the previous abnormalities, and the child had recovered completely as is usually the case.
These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.
Continue Reading
