An unusual case of cat scratch disease

Abstract

A 53-year-old man arrives in emergency room for fever, asthenia and weight loss. Few days before the visit, he was treated with amoxicillin/clavulanic acid for a hard and not much sore submandibular swelling, with no result. Both ultrasound and CT showed the presence of colliquative multiple nodes, as well as multiple areas of hypoechoic nodules in the liver and spleen, granulomas related to pathognomonics of the hepatosplenic form of disease. In spite of a silent medical history and the lack of exposure to animal or insects, he resulted positive to IgM anti-Bartonella, and the diagnosis of cat scratch disease was confirmed by biopsy. We decided to treat with an association of ertapenem 1g/day and teicoplanin 600 mg/day for 3 weeks, and thus we obtained the recovery. The case report is of particular interest because of the lack of guidelines, the unusual manifestation of the disease and the singular associations of drugs administered.