Yin QL, Liu YQ, Zhang HM, Zhang YL, Qi SM, Wen JQ, Zhang WH. Cat scratch disease in children with nocturnal fever: A case report. World J Clin Cases 2024; 12(35): 6840-6847 [DOI: 10.12998/wjcc.v12.i35.6840]
Corresponding Author of This Article
Wei-Hua Zhang, Doctor, Associate Chief Physician, Department of Pediatric Intensive Care Unit, Rainbow Hospital of Xianyang (Children's Hospital of Xianyang), No. 3 Weiyang West Road, Qindu District, Xianyang 721000, Shaanxi Province, China. xiangyuelanda2006@126.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Qi-Ling Yin, You-Qiong Liu, Hui-Min Zhang, Department of Pediatric, Shaanxi University of Chinese Medicine, Xianyang 721000, Shaanxi Province, China
Ya-Le Zhang, Department of Pediatric Respiratory, Rainbow Hospital of Xianyang (Children's Hospital of Xianyang), Xianyang 721000, Shaanxi Province, China
Shu-Min Qi, Department of Pathology, Rainbow Hospital of Xianyang (Children's Hospital of Xianyang), Xianyang 721000, Shaanxi Province, China
Jin-Quan Wen, Department of Pediatric Hematology/Oncology, Rainbow Hospital of Xianyang (Children's Hospital of Xianyang), Xianyang 721000, Shaanxi Province, China
Wei-Hua Zhang, Department of Pediatric Intensive Care Unit, Rainbow Hospital of Xianyang (Children's Hospital of Xianyang), Xianyang 721000, Shaanxi Province, China
Co-first authors: Qi-Ling Yin and You-Qiong Liu.
Author contributions: Yin QL and Liu YQ contributed equally to this study as co-first authors. Both of two authors have made equally significant contributions to the work and share equal responsibility and accountability for it. Yin QL and Zhang WH contributed to conception and design of the study; Zhang HM and Qi SM collected histopathological data; Zhang YL and Liu YQ organized the database; Yin QL drafted the manuscript; all authors contributed to manuscript revision, and have read and approved the submitted version.
Informed consent statement: The study participant’s legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Hua Zhang, Doctor, Associate Chief Physician, Department of Pediatric Intensive Care Unit, Rainbow Hospital of Xianyang (Children's Hospital of Xianyang), No. 3 Weiyang West Road, Qindu District, Xianyang 721000, Shaanxi Province, China. xiangyuelanda2006@126.com
Received: August 10, 2024 Revised: September 11, 2024 Accepted: October 10, 2024 Published online: December 16, 2024 Processing time: 74 Days and 18 Hours
Abstract
BACKGROUND
Cat scratch disease (CSD) is the most common human infection caused by Bartonella henselae (B. henselae). The main manifestation is self-limited lymphadenopathy that primarily affects adolescents, and typically resolves without treatment within 2-4 months. However, individuals with compromised immune systems or immunodeficiency require specific antibacterial therapy following diagnosis. Due to its low incidence, nonspecific clinical manifestations, and diagnostic limitations, this condition often poses challenges for clinicians in terms of missed diagnoses and misdiagnoses.
CASE SUMMARY
The child was ultimately diagnosed with CSD. The primary manifestations included nocturnal fever, enlargement of lymph nodes in the neck, axilla and groin, and suspected brucellosis; however, both brucellosis tests conducted during the course of the illness yielded negative results. Bone marrow cytology indicated stimulated proliferation. Lymph node biopsy indicated hyperplasia of lymphoid tissue in the cervical lymph nodes (right), with combined immunohistochemical findings indicating reactive hyperplasia. Immunohistochemical analysis revealed CD20 B (+), CD3 T (+), BCL-6 (+), and BCL-2 (-). CD21 FDC networks were present and Ki67 expression in the germinal center was ~80%. Blood next-generation sequencing indicated B. henselae sequence number was 3. Serological test results demonstrated positive antibody response to B. henselae IgG (+), B. henselae IgM (+), Bartonella quintana (B. quintana) IgG (-) and B. quintana IgM (-), and the final diagnosis was CSD.
CONCLUSION
In patients presenting with fever at night and swollen lymph nodes of unknown origin, CSD should be considered.
Core Tip: We report a case of cat scratch disease (CSD) characterized by nocturnal fever as the primary manifestation, accompanied by cervical and inguinal lymphadenopathy. In patients presenting with fever of unknown origin as the predominant symptom, a comprehensive physical examination and thorough medical history are essential to minimize the risk of missed or incorrect diagnosis. CSD is typically self-limiting and often does not require treatment, and symptomatic management and regular follow-up suffice for patients with milder symptoms. However, special attention should be given to immunodeficient and immunocompromised individuals who may require timely antimicrobial therapy.
