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Article in Japanese

A case of hepatosplenic cat-scratch disease presenting with fever of unknown origin

Akane TOMINAGA1), Noriko IKEDA1), Hiromu YAMADA1), Kasumi TASHIRO1), Sadatomo HARADA1), Masahiko OKADA2), Hiroyuki MORIUCHI2)

Cat-scratch disease (CSD) is a zoonosis associated with a history of scratch or bite by a cat and typically characterized by regional lymphadenopathy and fever. This study reported an atypical case of CSD characterized by persistent fever and multiple hepatosplenic abscesses, but lacking regional lymphadenopathy. A 12-year-old girl was admitted to this hospital due to a 5-day history of fever. She was treated empirically with cefotaxime and minocyclin, but remained febrile and developed right hypochondriac pain. Abdominal computed tomography and magnetic resonance imaging (MRI) on day 13 revealed the liver and spleen with multiple cystic lesions, which were consistent with hepatosplenic abscesses. Based on the aforementioned images, clinical manifestations, and new information that the girl had been in close contact with cats, she was suspected of having hepatosplenic CSD, which was confirmed by significantly high titers of anti-B. henseslae IgG and IgM. Upon treatment with sulbactum/cefoperazone, azithromycin and rifampicin, her condition improved and she was discharged on day 24. A follow-up MRI on day 61 showed improvement in the abdominal abscesses. CSD can be atypical, lacking regional lymphadenopathy and have a history of cat scratch. Clinicians should include CSD in a list of differential diagnoses of fever of unknown origin. Taking a history of animal contact and imaging studies may be useful for diagnosis.

1) Department of Pediatrics, Isahaya General Hospital
2) Department of Pediatrics, Nagasaki University Hospital

Key words Cat-scratch disease, fever of unknown origin, multiple hepatosplenic abscesses, atypical cases, lymphadenopathy
Received February 7, 2019
Accepted August 13, 2019

31 (4):347─353,2019