Cat Scratch Disease: A Case Confirmed by Nested Polymerase Chain Reaction

Abstract

Cat scratch disease (CSD) is the most common cause of localized chronic lymphadenopathy in children and adolescents in the US, but it is rarely reported in Taiwan. It is transmitted by Bartonella henselae. The diagnosis of CSD is usually made by clinical symptoms and compatible pathological findings. Recently, a serum antibody for B. henselae has been used to confirm the diagnosis; it is present in 88 to 100% patients. We report a 19.yelold female who bred cats and developed a painful inguinal node unresponsive to oral medicine. Biopsy showed a reactive lymph node with many epithelioid cell granulomas with central stellate suppurative necrosis and multinucleated giant cells. However, serum antibody to B. henselae by indirect immunoflorescence antibody test (IFA) was negative four weeks after onset of her symptoms. B. hensale DNA was finally detected in the lymph node biopsy specimen by means of nested polymerase chain reaction (PCR) and DNA sequence analysis, confirming the diagnosis of CSD.