Unusual eruption as a presenting symptom of cat scratch disease☆,☆☆,★

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Abstract

Cat scratch disease (CSD) is a common infectious cause of subacute regional lymphadenopathy. Bartonella henselae is the principal etiologic agent. About 10% of CSD patients experience atypical manifestations, including rashes. The most common cutaneous manifestation of CSD is a papule at the inoculation site. We report a case of CSD presenting with an eruption on the upper trunk, reminiscent of Sweet’s syndrome, accompanied by lymphadenopathy, arthralgia, and fever. Response to systemic corticosteroids was remarkable. Histopathologic findings refuted the diagnosis of Sweet’s syndrome. Identification of anti-B henselae antibodies and B henselae DNA in the affected lymph node confirmed the diagnosis of CSD. This is a first report of extensive papuloedematous eruption as a cutaneous manifestation of CSD. Accurate diagnosis is possible due to the availability of serological tests and DNA amplification techniques. (J Am Acad Dermatol 1999;41:833-6.)

Section snippets

CASE REPORT

A 32-year-old previously healthy woman was referred to the dermatology outpatient clinic because of fever of 39°C and eruption of 2 days duration. In addition, she complained of pain in the right groin and arthralgia in the right elbow, both knees and ankles, and the left first toe. The eruption, first noted on the upper chest, spread over the next 2 days to involve the shoulders and upper back. Although there was no pruritus, the lesions were accompanied by a mild burning sensation. Her past

DISCUSSION

The history of intense contact with cats, including numerous scratch marks, the presence of tender regional lymphadenopathy, the identification of anti-B henselae IgM and IgG, demonstrating a characteristic response of acute infection, as well as the identification of B henselae DNA in the affected lymph node, by PCR, leave no doubt regarding the diagnosis of CSD in our patient. B henselae , and rarely Afipia felis , are considered to be the etiologic agents of CSD.2 The disease affects mainly

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This supplement is made possible through an educational grant from Ortho Dermatological to the American Academy of Dermatology.

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Reprint requests: Marina Landau, MD, Department of Dermatology, Tel Aviv-Elias Sourasky Medical Center 6, Weizman Street, Tel Aviv 64239 Israel. E-mail: [email protected]

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