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Cat-Scratch Disease: Report of a Case with Liver Lesions and No Lymphadenopathy

Department of Radiology and Pathology, Vanderbilt University Medical Center, Nashville, Tennessee

Correspondence: For reprints contact: D. Delbeke, MD, PhD, Vanderbilt University Medical Center, Dept. of Radiology, Nashville, TN 37232.

ABSTRACT

The usual presentation of Cat-scratch disease (CSD) is a subacute regional lymphadenitis following cutaneous inoculation. We present the case of a 10-yr-old white female with a 4-wk history of abdominal pain and fever, without associated lymphadenopathy. A ⁶⁷Ga scintigram showed inhomogenous uptake by the liver. An abdominal computed tomographic (CT) scan revealed multiple low density lesions in the liver and the spleen, that were confirmed at laparotomy. Stellate microabscesses were seen on a wedge biopsy of the liver and a CSD antigen skin test was positive. CSD should be considered in the differential diagnosis of liver lesions, even in the absence of lymphadenopathy. This case emphasizes the importance of inhomogeneous ⁶⁷Ga uptake by the liver.