Cat Scratch Disease: A Diagnostic Challenge in Cervical Lymphadenopathy
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Abstract
Introduction: Cat scratch disease typically manifests as long standing regional lymphadenopathy, though clinical features may cover a wide spectrum. Lack of definite history of cat scratch, atypical presentation, non-availability of serological tests and misleading needle cytology may often lead to delay in diagnosis.
Case report: A 44 years old diabetic female, presented with persistent fever for 15 days followed by 4x4cm, tender tense swelling in left parotid region extending into upper neck. Her blood sugar was deranged. Polymorphonuclear leucocytosis was noted. Radiological investigation showed lymph nodal conglomeration involving level II, III and IV with non-enhancing necrotic areas within it. Mass was abutting Internal Jugular Vein, which was attenuated cranially. Aggressive antibiotics treatment and optimal glycemic control failed to resolve fever and lymphadenopathy, hence excision of neck mass was done which was reported histopathologically as Cat Scratch Disease.
Conclusion: While ruling out tuberculosis, Epstein Barr-Virus infection, acute bacterial lymphadenitis or malignant disease, Cat Scratch Disease should be included in the differential diagnosis of lymphadenopathies in head-neck region so that possibility of antibiotic abuse, an unnecessary biopsy, long term antitubercular drug therapy or even surgical treatment may be avoided.
Keywords: Cat Scratch Disease; Bartonella henselae; lymphadenopathy; serological test
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