![]() It usually follows a scratch or a bite from an animal (a cat or kitten in 90% of cases) and is caused by B henselae, a Gram-negative bacterium. ![]() At a follow-up visit 2 weeks later, the boy’s axillary swelling had significantly decreased, and all other symptoms had resolved.ĬSD is the most common cause of regional lymphadenitis in children and adolescents. Results were negative for B henselae IgM. Results of tests for Bartonella henselae ordered at the initial encounter subsequently showed an IgG titer of greater than 1:2,560. Ultrasonography of the right axilla was ordered but not performed due to patient adherence issues.Ī clinical diagnosis of cat-scratch disease (CSD) was made, and the patient was treated with a 5-day course of azithromycin. The results of a complete blood count, a comprehensive metabolic panel, and tests for lactate dehydrogenase and uric acid levels were all normal, and purified protein derivative test results were negative for Mycobacterium tuberculosis. The rest of the examination findings were unremarkable. On physical examination, he had a healing linear scar on his right hand ( A) and a tender lymph node in his right axilla measuring 4 cm in diameter ( B). His past medical history was unremarkable, and his immunizations were up to date. The family had 2 adult cats and a kitten at home, and the boy noted that the kitten had scratched his right hand 2 weeks before the onset of his symptoms. He also reported that he had had an enlarged lymph node below his chin 2 months ago that had resolved spontaneously. Initially, he had been diagnosed with pyogenic lymphadenitis at a local family clinic, and he had been treated with cefdinir without much improvement. He had not had a fever, but he had had some loss of appetite and malaise. A 4-year-old boy presented with tender swelling in his right axilla that had grown progressively for 4 weeks.
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