Abstract
Encephalopathy with fever has broad differentials including infectious, parainfectious, immune, paraneoplastic and metabolic causes. This Bartonella encephalitis patient demonstrates the importance of obtaining a complete environmental history, as the patient had five pet cats. Bartonella is a genus of gram negative bacteria, and the Bartonella henselae species is a causative agent of cat scratch disease, characterised by lymphadenopathy and fever. The serum testing was positive for B. henselae, with an immunoglobulin M (IgM) titre of 20 and an immunoglobulin G (IgG) titre of 512. The convalescent serology 6 months later, showed a fall in IgM titre to <20 and an IgG titre of 128. The patient was treated with acyclovir and ceftriaxone at presentation, with the addition of clarithromycin. She made a good functional recovery and was independent at discharge, with no new symptoms at the 24 month follow-up. A wide range of neurologic manifestations have been described in patients with Bartonella, including encephalopathy, transverse myelitis, polyradiculopathy, neuroretinitis, and cerebellar ataxia [1–4]. The patients with encephalopathy typically develop abrupt confusion and disorientation, which may progress to coma. Many of these patients will develop focal neurologic findings such as hemiparesis and seizures, due to the associated cerebral
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