Images in Infectious Diseases Klaudija Vikovi Saa Andraevi
- Slides: 9
Images in Infectious Diseases Klaudija Višković, Saša Andrašević, Denis Marušić
History • 65 years old male • Admitted to the hospital on the 6 th day after the onset of symptoms • Every day fever up to 39 ᵒC, headache and chills • Prior to admisson taking antipiretics and one dose of azithromycin
Lab • Laboratory findings at admission – L 11. 7, (seg 66. 1, ly 25, mo 8. 2, eo 0. 1, ba 0. 6)%, E 4, 90 Hgb 143, Htc 0, 413, MCV 84. 3, Trc 182 – CRP 108. 2 – Na 133, K 3. 8, Ca 2. 16 – Glucose 9. 4, BUN 6. 3, creatinin 93, Bil 13, AST 64, ALT 50, GGT 154, ALP 107, LDH 347 – Amilases/S 33, amilases/U 470 – PV 0. 74, INR 1. 2
Abdominal multislice computerized tomography
Abdominal multislice computerized tomography
Differential diagnosis Enlarged abdominal and retroperitoneal lymph nodes infectious diseases: tuberculosis other granulomatous diseases non-infectuous diseases: lymphoma Castelman’s disease
Final diagnosis • Bartonella hensleae Ig. M 20, Ig. G 512
Clinical manifestations of bartonellosis (Cat scratch disease) • • • Cutaneous manifestations Lymphadenopathy Visceral organ involvement Fever of unknown origin Ocular manifestations – Parinaud oculoglandular syndrome – Neuroretinitis • Neurologic manifestations • Musculoskeletal manifestations • Other atypical manifestations
Lymphadenopathy in bartonellosis • Regional lymphadenopathy is the hallmark of cat scratch disease (CSD). • The location of the lymphadenopathy depends on the site of the inoculation; the most common locations are the axillary, epitrochlear, cervical, supraclavicular, and submandibular lymph nodes. • Lymphadenopathy associated with CSD usually resolves in one to four months, but reports have described persistence of enlarged nodes for one to three years. • Less commonly, patients presented with several enlarged nodes in the same anatomic region. • In another study, regional adenopathy (single or multiple nodes) occurred in approximately two-thirds of cases, with the remaining one-third of patients having enlarged nodes in several anatomic sites*. • Generalized lymphadenopathy is rare. * Moriarty RA, Margileth AM. Cat scratch disease. Infect Dis Clin North Am. 1987 Sep; 1(3): 575 -90. Review.
