A 20 y.o. male presents with cervical adenopathy. He was referred for a biopsy.

he has large cervical nodes

Our patient had cat scratch fever.  His primary MD sent him to the ED because he was concerned for lymphoma because the pt had a 10 pound weight loss and a febrile illness.

cat saliva can transmit Bartonella

Cat scratch disease is caused by Bartonella henselae, A Gram-negative bacillus acquired from exposure to cats or cat fleas. It was first described by Parinaud in 1889 when he associated it with conjunctival injection. The organism contaminates feline saliva and can be isolated from the claws of kittens. It is a difficult species to culture and a serologic study of IgG is generally recommended to make the diagnosis.  While IgM indicates active infection, it only occurs over a very short time period and can be missed.

cat scratch disease was originally described in the eye: Parinaud’s oculoglandular syndrome

90% of cases present as regional lymphadenopathy but it can also present as osteomyelitis, endocarditis, encephalitis, and neuroretinitis. Individuals who are immune suppressed are at risk for the disease.

Cat scratch disease was suspected in our patient because he had an 8 month old cat and had been scratched multiple times.  He was treated with azithromycin.  Both IgM and IgG were positive for Bartonella and his adenopathy resolved over two weeks. 

Cats also have been shown to transmit MRSA, capnocytophaga canimorsus, leptospira and nocardia.

Rostad C, McElroy A, Hilinski J, et al. Bartonella henselai-mediated disease in solid organ transplant reipients: Two pediatric cases and a literature review. Transpl Infect Dis. 2012;14:E71-E81.

De Keukeleire S, Geldof J, De Clerck F, et al. Prolonged course of hepatic granulomatous disease due to Bartonella henselae. Acta Gastroenterol Belg. 2016;79:497-499

Parinaud H. conjonctivite infectieuse paraissant transmise a l’homme par les animaux. Soc Ophthalmol Paris. 1889;2:29-31.  infection. Acta Gastroenterol Belg 2016;79:497-499.