Background Although previously considered a rare cause of pyrexia of unknown origin(PUO), with the aid of new diagnostic tools the clinical spectrum of bartonella henselae infection has expanded.
Methods We present a case of a seven year old immunocompetent female patient who developed systemic symptoms mimicking an autoimmune rather than an infectious disease.
Results The patient, offspring of an unrelated Caucasian couple with uneventful past medical history, presented with erythematous papular rash, biquotidian fever, night sweats and arthralgias. There was no antecedent history of foreign travel or contact with animals. Investigations showed increased inflammatory markers (ESR 86,CRP 80 [range 0-10mg/dl)], thrombocytosis, hypercalcemia and raised ALP and angiotensin converting enzyme(ACE). Quantiferon test was negative. Abdominal imaging (USS followed by MRI) showed multifocal calcified granulomas of the liver and spleen, chest radiograph showed enlarged hilar lymph nodes; ophthalmology review showed low grade panuveitis. Diffrentials included systemic JIA, small vessel vasulitides and sarcoidosis. Clinical, laboratory and imaging features pointed towards sarcoidosis. However, subsequent raised titers (IgM 1:32, IgG 1:256) against bartonella confirmed the diagnosis of B. henselae infection. She tested negative for HIV1+2 and lymphocyte subset analysis did not reveal an underlying primary immunodeficiency. She was treated with intravenous gentamycin followed by oral ciprofloxacin.Pyrexia and rash subsided with 24 hours; repeat investigations showed complete resolution of findings.
Conclusions Conclusion: The presence of hepatic and splenic lesions in children with bartonellosis is well documented. Our case however, exhibited certain unusual findings such as the co-existence of ocular and solid organ involvement as well as the presence of calcifications during the acute phase. Serological testing is an inexpensive and effective way to diagnose bartonellosis in immunocompetent patients; we suggest that bartonella serology is included in the baseline tests performed in immunocompetent children with PUO even in the absence of contact with cats.
Florin TA, Zaoutis TE, Zaoutis LB Beyond cat scratch disease: widening spectrum of Bartonella henselae infection. Pediatrics. 2008 May;121(5):e1413-25.
Ventura A, Massei F, Not T, Massimetti M, Bussani R, Maggiore G Systemic Bartonella henselae infection with hepatosplenic involvement. J Pediatr Gastroenterol Nutr. 1999 Jul;29(1):52-6.
Disclosure of Interest None Declared
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