A Serological Test Negative Case of Suspected Cat Scratch Disease with Fever and Lymphadenopathy Detecting by Gallium Planar and SPECT Scan: A Case Report and Discussion

Abstract

Cat-scratch disease is an infectious disease ranging from very mild localized disease to severe dissiminated disease but self limited and is not contagious to others. This new zoonotic disease was first reported in Taiwan in 1998. Most of them had history of cat feeding at home. The history of cat bite or scratch is not always clear even when the patients themselves are asked. Palpable swollen lymph nodes are usually noted by the patient. We report an adult woman who had a definite history of being scratched by a cat and then developed ipsilateral axillary and elbow painful lymph nodes swelling associated with fever. The cat scratched site is beneath the right elbow region. Then, she was hospitalized for nine days for antibiotic therapy. During admission period, she was surveyed with gallium scan and SPECT. The focally involved lymph nodes are well demonstrated by scintigraphy in right axillary and elbow lymph nodes. The findings were well correlated with clinical history and symptom. This reminds us gallium inflammatory scan could be a routine scan and is helpful for the diagnosis of cat scratch disease, especially for children or immune system suppressed patients or even for normal healthy adults. Diseases mimicking cat scratch disease in imaging diagnosis are diverse and further clinical laboratory and history reviews are very important for differentiation because of variations. Serum antibody study of this case is negative though Bartonella henselae is the most cause of this disease, there are other rare causes to our knowledge. So, we attribute this case to be a suspicious case of cat scratch disease because it does not meet the at least three of four criteria of cat scratch disease. According to the reports of the Center for Disease Control (CDC) reports for cat scratch disease in Taiwan, there were only 12 and 8 proven true positive cases in 2007 and 8 cases in 2008, respectively. Since the diagnostic rate of CSD is not high, so we expect new polymerase chain reaction (PCR) technology could be used to increased the sensitivity for the diagnosis of CSD.