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The Journal of Pediatric Infectious Diseases and Immunology > Vol.33 No.1 contents > Abstract

Article in Japanese

An atypical case of cat scratch disease presenting with uveitis and multiple renal lesions

Daichi HAYASHI1), Minako KAWAMOTO1), Norio KAWAMOTO1), Hidenori OHNISHI1)

Cat scratch disease(CSD) is a zoonosis caused by Bartonella henselae. Typical CSD is characterized by multiple lymphadenopathy, whereas atypical CSD can present with various systemic symptoms. This paper reports an atypical case of CSD presenting with eye and renal lesions.
A 13-year-old girl was admitted to this hospital due to fever of unknown origin. She had no fever or lymphadenopathy on admission. However, a blood and fundus examination showed increased inflammatory response and uveitis, respectively. The patient then developed an intermittent fever during hospitalization. Contrast-enhanced computed tomography showed a patchy non-contrast area in the bilateral renal parenchyma. An oxacephem antibiotic was administered systemically because acute focal bacterial nephritis was suspected initially, and her fever declined 3 days later. However, magnetic resonance imaging was performed to evaluate the effect of treatment, which revealed residual renal lesions. CSD was then diagnosed based on increasing serum B. henselae antibody titer, and a new quinolone antibiotic was added. After this additional antibiotic therapy, the renal lesions disappeared and the patient was discharged. Her renal lesions were still absent 1 month after discharge, and follow-up was discontinued because her symptoms had not relapsed after another 3 months.
This was a rare atypical case of CSD involving both eye and renal lesions. It is important to obtain all history of animal contact, perform a fundus examination, and assess the function of deep organs closely, including the kidneys, in patients with fever of unknown origin with or without lymphadenopathy.

1) Department of Pediatrics, Graduate School of Medicine, Gifu University

Key words cat scratch disease, fever of unknown origin, uveitis, multiple renal lesions, atypical case
Received July 13, 2020
Accepted November 18, 2020

33 (1):22─29,2021