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Today at international @CPSolvers.
15-year-old female
with retroauricular and preauricular adenitis, left lumbar pain, splenomegaly and 2.5 kg weight loss in 22 days.
What is the most likely diagnosis?
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@SandraF73382667 @Felipesolares @rabihmgeha
Today at international @CPSolvers.
15-year-old female
with retroauricular and preauricular adenitis, left lumbar pain, splenomegaly and 2.5 kg weight loss in 22 days.What is the most likely diagnosis?
Follow the
@SandraF73382667 @Felipesolares @rabihmgeha
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- Lumbar X ray shows scoliosis w/ right concavity
- Bone scintigraphy: pathological uptake in L1
- PCR: 38.3 mg/dl (NL 0-5)
- Lumbar X ray shows scoliosis w/ right concavity
- Bone scintigraphy: pathological uptake in L1
- PCR: 38.3 mg/dl (NL 0-5)
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- Spleen ultrasound showed multiple hypoechoic lesions suggestive of microabscess.
- Spleen ultrasound showed multiple hypoechoic lesions suggestive of microabscess.
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With all this information. What do you think is the most likely dx?
With all this information. What do you think is the most likely dx?
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The correct answer is disseminated Cat Scratch Disease (CSD).
When dealing with a young patient with regional adenitis and constitutional symptoms like weight loss or FUO, you should keep a high index of suspection for CSD.
The correct answer is disseminated Cat Scratch Disease (CSD).
When dealing with a young patient with regional adenitis and constitutional symptoms like weight loss or FUO, you should keep a high index of suspection for CSD.
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"A prospective analysis of 146 children with fever of unknown origin and prolonged fever found that B. henselae was the third most common infectious disease diagnosis" (Jacobs, 1998)
https://pubmed.ncbi.nlm.nih.gov/9455513/
https://www.uptodate.com/contents/microbiology-epidemiology-clinical-manifestations-and-diagnosis-of-cat-scratch-disease
"A prospective analysis of 146 children with fever of unknown origin and prolonged fever found that B. henselae was the third most common infectious disease diagnosis" (Jacobs, 1998)
https://pubmed.ncbi.nlm.nih.gov/9455513/
https://www.uptodate.com/contents/microbiology-epidemiology-clinical-manifestations-and-diagnosis-of-cat-scratch-disease
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The B. henselae seropositivity in a cross-sectional study in Peru
including 106 children (5-11 yo) with regional adenitis and 5 days of symptoms was 81.1%
https://rpmesp.ins.gob.pe/index.php/rpmesp/article/view/45/1959
The B. henselae seropositivity in a cross-sectional study in Peru
including 106 children (5-11 yo) with regional adenitis and 5 days of symptoms was 81.1%https://rpmesp.ins.gob.pe/index.php/rpmesp/article/view/45/1959
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Some pearls about CSD:
Etiological factor: B. henselae
Main reservoir: Infected cats
Typical clinical manifestation: Autolimitated regional adenitis near site of inoculation
https://www.uptodate.com/contents/microbiology-epidemiology-clinical-manifestations-and-diagnosis-of-cat-scratch-disease
Some pearls about CSD:
Etiological factor: B. henselae Main reservoir: Infected cats Typical clinical manifestation: Autolimitated regional adenitis near site of inoculationhttps://www.uptodate.com/contents/microbiology-epidemiology-clinical-manifestations-and-diagnosis-of-cat-scratch-disease
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B. henselae can act like M. tuberculosis and involve many organs: liver, spleen >> others (SNC, eye, bones, heart, and many others) - like in this case.
Disseminated CSD treatment: rifampin + azithromycin
https://www.uptodate.com/contents/microbiology-epidemiology-clinical-manifestations-and-diagnosis-of-cat-scratch-disease
B. henselae can act like M. tuberculosis and involve many organs: liver, spleen >> others (SNC, eye, bones, heart, and many others) - like in this case. Disseminated CSD treatment: rifampin + azithromycinhttps://www.uptodate.com/contents/microbiology-epidemiology-clinical-manifestations-and-diagnosis-of-cat-scratch-disease
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Take- home message: Never forget to include in your differential diagnosis cat scratch disease in a patient with regional adenitis and FUO or weight loss!
Have a nice day :)
Take- home message: Never forget to include in your differential diagnosis cat scratch disease in a patient with regional adenitis and FUO or weight loss!Have a nice day :)
