Hepatosplenic Cat‐Scratch Disease in Children: Selected Clinical Features and Treatment

Abstract

We reviewed 19 cases of hepatosplenic cat-scratch disease at Texas Children's Hospital (Houston). The range of the patients' ages was 2 years 4 months to 11 years 8 months. The chief complaint was fever for all patients. The duration of fever before diagnosis was 7 to 56 days (mean, 22 days). Abdominal pain was present in 13 patients (68%). Thirteen children were treated with rifampin alone, and three received rifampin therapy plus gentamicin or trimethoprim-sulfamethoxazole. Once rifampin therapy was initiated alone or in combination, improvement was noted within 1 to 5 days (mean, 2.6 days) for patients who had had prolonged fever the duration of which before rifampin therapy averaged 3 weeks. The most common dosage and duration for our patients were 20 mg/[kgrd] every 12 hours and 14 days, respectively. Rifampin should be considered in the initial antimicrobial treatment of hepatosplenic cat-scratch disease.

Identification of Bartonella henselae in the Liver of a Thoroughbred Foal with Severe Suppurative Cholangiohepatitis

“…In humans, doxycycline, erythromycin and rifampin are commonly recommended antibiotics for treatment of various Bartonella infections, but clinical amelioration also has been documented with other classes of drugs 7. For hepatosplenic syndromes in people, there is anecdotal evidence that treatment with gentamicin, TMS, rifampin and ciprofloxacin, used alone or in combination, has been effective 6, 8. In the foal of this report, clinical response was observed during treatment with TMS and rifampin, but B. henselae still was identified in the liver by enrichment PCR at a 4‐month re‐evaluation.…”

“…In people, the typical acute B. henselae infection, known as cat scratch disease, most commonly results in fever and regional lymphadenopathy 6, 7. An atypical form of B. henselae infection resulting in granulomatous hepatitis has been reported in humans, most commonly in children and in liver transplant recipients 8, 9. A recent report by Venderhayden et al reported necrotizing granulomatous hepatitis in an immunocompetent woman, and B. henselae was amplified by PCR using blood and surgically removed liver tissue 10.…”

Acute hemiplegia associated with cat-scratch disease

“…Some cases are more severe and more protracted, and may last up to six to seven months. Other reports have described persistence of enlarged nodes for one to three years [2].…”

“…Atypical forms of CSD are characterized by ocular or neurological manifestations, hepatosplenic involvement, vertebral osteomyelitis and other atypical manifestations [1][2][3]. Although the primary diagnosis of CSD is clinical, it can be diagnosed reliably with serologic testing and histopathology.…”

Enfermedad por arañazo de gato complicada con compromiso sistémico, osteomielitis osteovertebral y absceso paravertebral

“…En casos de presentación atípica y diseminada se describen hallazgos característi-cos que permiten en muchos de ellos establecer el diagnóstico, como el compromiso granulomatoso de hígado y bazo, con o sin hepatoesplenomegalia, con múltiples lesiones redondeadas, ovales o irregulares de diferente diámetro, hipodensas en los exámenes tomográficos, las cuales desaparecen o se calcifican después de semanas o meses. 1,[6][7][8] Este paciente no mostró compromiso hepático ni esplenomegalia al examen clínico.…”