Case report
Cat Scratch Disease: An Unusual Cause of Facial Palsy and Partial Ptosis: Case Report

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Report of a Case

A 29-year-old woman was referred to the maxillofacial surgery department at Leeds Dental Institute (Leeds, England) in March 2002. She presented with complaints of pain and swelling over the left parotid gland for 5 weeks. The swelling had gradually increased in size and was associated with a swollen left eye and she was unable to raise her left eyelid. She was also complaining of slight and transient weakness of the left side of the face for the past week. She was lethargic and complained of

Discussion

Patients with CSD are likely to own a cat aged 12 months or younger, to have been scratched or bitten by a kitten, and to have at least 1 kitten infested with fleas.1 The traumatic cat contact results in either bacillary angiomatosis in the immunocompromised patient or CSD in the immunocompetent patient.

As a general rule, the diagnosis is favored by chronicity (more than 3 weeks), unilateral occurrence, tenderness, and characteristic sites of involvement, such as the axillary, epitrochlear, and

Acknowledgment

The authors thank Mr Russell, the consultant oral and maxillofacial surgeon and Dr E. Minton, the consultant physician in the department of infectious diseases and tropical medicine, for allowing us to present their patient.

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    It is worth noting that this patient had 2 days of valacyclovir prior to transfer of care, while not a therapeutic dosage, it may have delayed the HSV diagnosis. While there are two previously reported cases of patients with unilateral facial droop due to presumed CSD NR, one case was subsequently found to have a secondary granulomatous lesion compressing the facial nerve and neither case was tested for HSV serologies.10–12 Retrospectively, the patient's right facial palsy was likely secondary to an active HSV infection given the clinical history, serologies, and neuroimaging demonstrating right facial nerve enhancement.

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