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Year : 2006  |  Volume : 16  |  Issue : 3  |  Page : 341-343
Cat scratch disease presenting as right lower arm swelling

Department of Radio-Diagnosis, Medical Trust Hospital, Kochi-16,Kerala, India

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Keywords: Cat scratch disease

How to cite this article:
Jacob J, Gaikwad A, Ghadge P. Cat scratch disease presenting as right lower arm swelling. Indian J Radiol Imaging 2006;16:341-3

How to cite this URL:
Jacob J, Gaikwad A, Ghadge P. Cat scratch disease presenting as right lower arm swelling. Indian J Radiol Imaging [serial online] 2006 [cited 2020 May 25];16:341-3. Available from:

   Introduction Top

Cat scratch disease is a relatively rare infective disease caused by Bartonella henselae.The usual presenting feature is regional lymphadenopathy ,usually involving the axillary,head and neck and inguinal region. We present this case of a boy presenting with a painful swelling in the right lower arm. The diagnosis was confirmed on MRI and histopathological findings.

   Case summary Top

A 21 years old boy presented with a painful swelling of right lower arm medially . The swelling was small initially, which gradually increased in size over a period of 3 months.

The swelling was soft to firm in consistency and mildly tender on palpation. Plain and contrast enhanced MRI of the right arm was done which revealed a faintly enhancing well defined smooth marginated space occupying lesion showing small areas of central fatty signal intensity in the subcutaneous soft tissues of the medial aspect of distal right arm superior to the medial epicondyle and medial to the distal portions of the long and medial heads of triceps muscle and the brachialis muscle( Images1-6 ). The possibility of a significantly enlarged epitrochlear lymph node due to an inflammatory aetiology was given and subsequently was evaluated further by biopsy and histopathological examination, which showed granulomatous inflammation with central stellate necrosis. Retrospectively, the patient gave history of contact with cat. The patient also had developed a pustule over the dorsum of right hand two weeks prior to development of the right arm swelling.

   Image keys Top

Image1 - T1weighted axial

Image2 - T2 weighted coronal

Image3 - STIR coronal

Image4 - T1W1 coronal

Image5 - Post contrast T1 axial

Image6 - Post contrast T1 coronal

   Discussion Top

During the period of important discovery of microbiological agent causing cat scratch disease , novel microbial culprits have been introduced and new groups of affected

patients have been recognized. Approximately 900 publications have dealt with CSD since the first good clinical description of the disease in 1950 [1]

The genus Bartonella comprises several important human pathogens that cause a wide range of clinical manifestations: cat-scratch disease, trench fever, Carrion's disease, bacteremia with fever, bacillary angiomatosis and peliosis, endocarditis, and neuroretinitis. Bartonellae have some features in common which include transmission by blood-sucking arthropods and the specific interaction with endothelial cells and erythrocytes of their mammalian hosts. Bartonellae subvert multiple cellular functions of human endothelial cells, resulting in cell invasion, proinflammatory activation, suppression of apoptosis, and stimulation of proliferation, which may cumulate in vasoproliferative tumor growth[2] The cat flea, Ctenocephalides felis, is the recognised vector of Bartonella henselae, B. clarridgeiae and Rickettsia felis. Although these Gram-negative bacteria were only described in the last decade, they are already known to cause a variety of diseases in people, particularly children and the immunosuppressed. Such diseases include cat-scratch disease, bacillary angiomatosis, endocarditis, bacteraemia, encephalopathy, neuroretinitis, osteomyelitis and peliosis hepatis. In 2004, DNA of B. henselae, B. clarridgeiae and R. felis was demonstrated in cat fleas from New Zealand [3]

Clinical Features of CSD:

CSD is typically a benign and self-limited illness lasting 6 to 12 weeks in the absence of antibiotic therapy. Regional lymphadenopathy (axillary, head and neck, inguinal) is the predominant clinical feature of CSD; affected nodes are often tender and occasionally suppurate [4],[5],[6],[7]. Between 25% and 60% of patients report a primary cutaneous inoculation lesion (0.5- to 1-cm papule or pustule) at the site of a cat scratch or bite [5],[6],[7].

The skin lesions typically develop 3 to 10 days after injury and precede the onset of lymphadenopathy by 1 to 2 weeks. Low-grade fever and malaise accompany lymphadenopathy in up to 50% of patients; headache, anorexia, weight loss, nausea and vomiting, sore throat, and splenomegaly may develop. In addition, short-lived, non-specific maculopapular eruptions, erythema nodosum, figurate erythemas, and thrombocytopenic purpura have been observed [8].

Unusual manifestations of CSD, which occur in up to14% of patients, include Perinaud's oculoglandular syndrome (6%), encephalopathy (2%), hepatic granulomas(0.3%), osteomyelitis (0.3%), and pulmonary disease (0.2%) [4],[5],[8]. In general, these complications resolve without sequelae. Perinaud's oculoglandular syndrome is manifested by conjunctival granuloma, periauricular lymphadenopathy, and nonsuppurative conjunctivitis. Encephalopathy, manifested as fever and coma that progress to convulsions, may last for days to weeks; cerebrospinal fluid is unremarkable.

Optic neuritis with transient blindness may also occur.

   References Top

1.Emmons RW, Riggs JL, Schachter J. Continuing the search for the etiology of cat scratch disease. J Clin Micro Biol 1976;4:112-4.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Dehio C. Molecular and cellular basis of bartonella pathogenesis.Annu Rev Microbiol. 2004;58:365-90.  Back to cited text no. 2    
3.Kelly PJ. N Z Vet J. 2004 Dec;52(6):352-7.  Back to cited text no. 3    
4.Carithers HA. Cat scratch disease: An overview based on a study of 1,200 patients. Am J Dis Child 1985; 139:1124-33.  Back to cited text no. 4  [PUBMED]  
5.Margileth AM. Cat scratch disease. Adv Pediatr Infect Dis 1993;8:1-21.  Back to cited text no. 5  [PUBMED]  
6.Karim AA, Cockerell CJ, Petri WA. Cat scratch disease, bacillary angiomatosis, and other infections due to Rochalimaea. N Engl J Med 1994;330:1509-15.  Back to cited text no. 6    
7.Zangwill KM, Hamilton DH, Perkins BA, et al. Epidemiology, risk factors, and evaluation of a new diagnostic test. N Engl J Med 1993;329:8-13.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Warwick WJ. The cat-scratch syndrome, many diseases or one disease? Prog Med Virol 1967;9:256-301.  Back to cited text no. 8  [PUBMED]  

Correspondence Address:
J Jacob
Department of Radio-Diagnosis, Medical Trust Hospital, Kochi-16,Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-3026.29012

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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]


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