Abstract
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.
2014 BMJ Publishing Group Ltd.
MeSH terms
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Animals
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Anti-Bacterial Agents / therapeutic use
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Azithromycin / therapeutic use
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Bartonella henselae*
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Cat-Scratch Disease / complications*
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Cat-Scratch Disease / diagnosis
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Cat-Scratch Disease / drug therapy
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Cat-Scratch Disease / microbiology
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Cats
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Duodenal Diseases / drug therapy
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Duodenal Diseases / etiology*
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Duodenal Diseases / microbiology
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Duodenal Diseases / pathology
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Duodenum / microbiology
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Duodenum / pathology
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Female
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Humans
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Immunoglobulin M / blood
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Liver / microbiology
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Liver / pathology
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Liver Diseases / drug therapy
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Liver Diseases / etiology*
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Liver Diseases / microbiology
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Liver Diseases / pathology
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Lymph Nodes / microbiology
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Lymph Nodes / pathology
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Lymphatic Diseases / drug therapy
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Lymphatic Diseases / etiology*
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Lymphatic Diseases / microbiology
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Lymphatic Diseases / pathology
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Middle Aged
Substances
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Anti-Bacterial Agents
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Immunoglobulin M
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Azithromycin