Detection of Bartonella henselae – DNA in macronodular hepatic lesions of an immunocompetent woman

Abstract

Bartonella henselae is the aetiological agent of catscratch disease (CSD), a benign cause of localised lymphadenopathy, which often recovers spontaneously. Hepatic granulomatosis, such as other systemic clinical presentations, is generally described in individuals affected by immunodeficiency but it is rarely reported in immunocompetent patients [1–3]. We report a case of a 34-year-old immunocompetent woman with hepatic localisation of cat scratch disease. The patient was admitted to the hospital for iridocyclites and keratitis. She reported mild asthenia and sporadic fever associated with biological inflammatory syndrome (VES, 67mm; PCR, 8.8 mg ⁄dL). Routine haematologic controls revealed hepatic injury (ALA, 101 U ⁄L; AST, 208 U ⁄L; CHE, 2209; LDH, 702 U ⁄L; fibrinogen, 540 mg ⁄dL) associated with mild coagulation disorders (PT 63%; PTT 35.5¢¢; INR 1.39). Abdominal ultrasonography revealed hepatomegaly with multiple macronodular lesions in the right segments of the liver, associated with peripancreatic lymphadenopathy. Autoimmunity and Wilson disease, and the agents responsible for liver infection (BK, HCV, HBV, HAV and TORCH agents), were excluded. HIV test was negative. A subsequent biopsy of the macronodular lesions showed epithelioid granulomas. The patient lived in the countryside and she had sporadic contacts with outdoor cats. She didn’t report having been scratched or bitten by cats or dogs. Weil-Felix reaction was positive (OX19 1:80; OXK 1:160). Antibodies against zoonotic agents were investigated.