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BMJ Case Reports 2014; doi:10.1136/bcr-2014-203626
  • CASE REPORT

Cat scratch disease, a rare cause of hypodense liver lesions, lymphadenopathy and a protruding duodenal lesion, caused by Bartonella henselae

  1. Alje van Dam4
  1. 1Department of Gastroenterology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  2. 2Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  3. 3Department of Pathology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  4. 4Department of Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  1. Correspondence to Marloes van Ierland-van Leeuwen, marloes.vanierland{at}gmail.com
  • Accepted 15 October 2014
  • Published 29 October 2014

Summary

A 46-year-old woman presented with right upper abdominal pain and fever. At imaging, enlarged peripancreatic and hilar lymph nodes, as well as hypodense liver lesions, were detected, suggestive of malignant disease. At endoscopy, the mass adjacent to the duodenum was seen as a protruding lesion through the duodenal wall. A biopsy of this lesion, taken through the duodenal wall, showed a histiocytic granulomatous inflammation with necrosis. Serology for Bartonella henselae IgM was highly elevated a few weeks after presentation, consistent with the diagnosis of cat scratch disease. Clinical symptoms subsided spontaneously and, after treatment with azithromycin, the lymphatic masses, liver lesions and duodenal ulceration disappeared completely.

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