BMJ Case Reports 2018; doi:10.1136/bcr-2017-223647
  • Unusual presentation of more common disease/injury

Encephalopathy in an adult with cat-scratch disease

  1. Mina Psichogiou1,2
  1. 11st Department of Medicine, Laikon Hospital, Athens, Greece
  2. 21st Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
  1. Correspondence to Professor Michael Samarkos, msamarkos{at}
  • Accepted 9 February 2018
  • Published 5 March 2018


We report the case of a 53-year-old healthy man, presenting with confusion. The patient had been clinically diagnosed with cat-scratch disease (CSD) and prescribed a 10-day course of doxycycline orally. Approximately a week after he had completed the treatment, he was admitted to our department with confusion. Neurological examination revealed expressive dysphasia with no motor or sensory deficits. Cerebrospinal fluid (CSF) examination showed only increased content. Imaging with CT and MRI of the brain did not reveal any abnormalities, and funduscopy was normal. Serology confirmed Bartonella henselae infection. CSD-associated encephalopathy was confirmed based on the clinical manifestations, CSF findings and positive serology. The patient was treated with a combination of doxycycline and rifampin and he rapidly improved with complete neurological recovery within 7 days. Encephalopathy is an unusual manifestation of CSD in adults with excellent prognosis.


  • Contributors MS: Reviewed the literature; wrote the final version of the manuscript. VA: Collected patient data; wrote the first draft of the manuscript; searched and reviewed the literature. AGV: Reviewed the literature; wrote part of the first draft. MP: Collected patient data; critically reviewed the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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