EP349 - SUPURATIVE CERVICAL LYMPHADENOPATHY WITH “7 LIVES” (ID 1461)
Abstract
Title of Case:
SUPURATIVE CERVICAL LYMPHADENOPATHY WITH “7 LIVES”
Background:
Cat scratch disease (CSD) usually presents as a self-limiting lymphadenopathy. Its main cause is Bartonella henselae, a common pathogen of chronic cervical lymphadenitis in pediatric age. Wait-and-see is usually the preferred approach, however prolonged cases may need surgical intervention.
Case Presentation Summary:
An 11-year-old female presented with a 1-year history of a painful right submandibular adenopathy. Serologic testing was positive for Bartonella species. Due to the development of inflammatory signs and fluctuation, incision and drainage was performed. During the following year, 5 episodes of suppuration occurred, and a chronic sinus tract was identified in echography. Needle-aspiration cytology was performed, but the biopsy was inconclusive. In a 2-year-period, she underwent a total of 7-antibiotic-cycles. Only the complete surgical excision of the lesion solved the symptoms. Histochemical analysis was compatible with CSD, and PCR assay positive for Bartonella spp.
Learning Points/Discussion:
The lymphoadenopathy in CSD is probably due to an immunological reaction, and antibiotic therapy is usually ineffective. Excisional drainage is not recommended due to the potential formation of sinus tract, as seen in this case. Complete excision is advocated in chronic cases, allowing a quick resolution of the symptoms.
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