Önder KİLİÇASLAN, Didem KIZMAZ İŞANÇLI, Esmanur FİL, Adem KARBUZ

Nadir Bir Lenfadenopati Nedeni Olarak Kedi Tırmığı Hastalığı; Bir Olgu Sunumu

Kedi tırmığı hastalığı Bartonella Henselae tarafından meydana gelir. Kedilerin tırnakları ile oluşturduğu çizikler veya ısırma yolu ile bulaşır. Tek taraflı ağrılı aksiller lenfadenopati ile başvuran 14 yaş kız hastayı kedi tırmığı hastalığı tanısı alması nedeniyle sunduk. Öyküsünde yavru kediler ile teması olduğu öğrenildi. Tetkiklerinde beyaz küre sayısı 17630 uL, C-Reaktif protein 30 mg/L, sedimentasyon 42 mm/saat saptandı. Sağ aksiller yüzeyel ultrasonografik incelemesi ve magnetik rezonans görüntülemesi abse ve lenfadenopati olarak yorumlandı. Hastaya sulbaktam-ampisilin ve azitromisin başlandı. Ayırıcı tanıda araştırılan viral ve tipik bakteriyel etkenlere yönelik testler negatifti. Abse drenajından alınan örneğe yönelik yapılan tetkiklerde Bartonella henselae Real Time PCR ve serum Bartonella henselae IgG sonucu pozitif saptandı. Tek taraflı lokalize lenfadenopati nedeniyle başvuran hastalarda kediler ile temas irdelenmeli, ayırıcı tanı özenle yapılmalıdır.

Anahtar Kelimeler:

Çocuk, Kedi, Kedi Tırmığı Hastalığı, Lenfadenopati

Cat Scratch Disease as a Rare Cause of Lymphadenopath; A Case Report

Cat scratch disease is caused by Bartonella Henselae. It is transmitted by scratches or bites of cats. We report a 14-year-old female patient who presented with unilateral painful axillary lymphadenopathy, since she was diagnosed with cat scratch disease. She had close contact with kittens in her medical history. In laboratory findings white blood cell count was 17630 ul, C-Reactive protein 30 mg/L, sedimentation was 42 mm/hour. Superficial ultrasonographic examination and magnetic resonance imaging of right axillary area showed abscess and lymphadenopathy. Sulbactam ampicillin and azithromycin were given to the patient. Tests for viral and typical bacterial agents were negative in the differential diagnosis. Abcess drainage specimen was found to be positive for Bartonella henselae Real Time PCR and serum Bartonella henselae IgG was positive. In patients presenting with unilateral localized lymphadenopathy, history of close contact with the cats should be questioned and the differential diagnosis should be made carefully.

Keywords:

Child, Cat, Cat Scratch Disease, Lymphadenopathy,

PDF

___

1. Bejarano AP, Del Moral RS, Guisado-Gil AB. Bartonella henselae encephalopathy in a paediatric patient: A case report and treatment review. J Clin Pharm Ther. 2020;45(4):840-4. doi: 10.1111/jcpt.13178.
2. Ridder GJ, Boedeker CC, Technau-Ihling K, Sander A. Cat-scratch disease: Otolaryngologic manifestations and management. Otolaryngol Head Neck Surg. 2005;132(3):353-8. doi: 10.1016/j.otohns.2004.09.019.
3. Sandoval AC, Reyes FT, Prado MA, Peña AL, Viviani TN. Cat-scratch Disease in the Pediatric Population: 6 Years of Evaluation and Follow-up in a Public Hospital in Chile. Pediatr Infect Dis J. 2020;39(10):889-93. doi: 10.1097/INF.0000000000002708.
4. Pennisi MG, Marsilio F, Hartmann K, Lloret A, Addie D, Belák S, et al. Bartonella species infection in cats: ABCD guidelines on prevention and management. J Feline Med Surg. 2013;15(7):563-9. doi: 10.1177/1098612X13489214.
5. Chang CC, Lee CJ, Ou LS, Wang CJ, Huang YC. Disseminated cat-scratch disease: case report and review of the literature. Paediatr Int Child Health. 2016;36(3):232-4. doi: 10.1179/2046905515Y.0000000005.
6. Prudent E, Lepidi H, Audoly G, La Scola B, Fournier PE, Edouard S, et al. Bartonella henselae is usually not viable in lymph nodes of patients with cat scratch disease. Eur J Clin Microbiol Infect Dis. 2017;36(11):2207-13. doi: 10.1007/s10096-017-3047-z.
7. Klotz SA, Ianas V, Elliott SP. Cat-scratch Disease. Am Fam Physician. 2011;83(2):152-5.
8. Chaudhry R, Kokkayil P, Ghosh A, Bahadur T, Kant K, Sagar T, et al. Bartonella henselae infection in diverse clinical conditions in a tertiary care hospital in north India. Indian J Med Res. 2018;147(2):189-94. doi: 10.4103/ijmr.IJMR_1932_16.
9. Tey MS, Govindasamy G, Vendargon FM. The clinical spectrum of ocular bartonellosis: a retrospective study at a tertiary centre in Malaysia. J Ophthalmic Inflamm Infect. 2020;10(1):31. doi: 10.1186/s12348-020-00224-0.
10. Conrad DA. Treatment of cat-scratch disease. Curr Opin Pediatr. 2001;13(1):56-9. doi: 10.1097/00008480-200102000-00010.