Cat Scratch Research Articles

Cat Scratch Disease in Children

The aim of this paper is to provide information on the clinical manifestations, diagnosis and treatments of Bartonella henselae infection in children. Cat scratch disease (CSD) is a zoonosis caused by Bartonela henselae. Cat fleas are responsible for spreading the bacterium among cats. Bacteria can be transmitted to humans from the site of a cat bite or scratch. The typical manifestation of CSD is regional lymphadenopathy with a pustule at the site of inoculation, usually self-limiting. Atypical CSD has a wide range of clinical manifestations (hepatosplenic disease, pulmonary infiltrates, encephalitis, skin or bone involvement, endocarditis), some of which are life-threatening. Atypical presentations mainly occur in immunocompromised children, but have also been described in immunocompetent children.Conclusion − In recent years the number of households with a pet is growing and the number of children visiting a pediatrician with CSD is growing.

Multi-locus Sequencing Typing of Bartonella henselae isolates reveals coinfection with different variants in domestic cats from Midwestern Brazil

Bartonella henselae is a zoonotic pathogen responsible for causing Cat Scratch Disease (CSD) and other clinical manifestations in humans. Domestic cats are the main reservoirs of this Bartonella species. Previous studies have suggested that certain genotypes of B. henselae seem to be more associated with human infections. The present study aimed to genotype B. henselae isolates from domestic cats’ blood samples in the state of Goiás, midwestern Brazil. The association of quantitative real-time PCR (qPCR) based on the nuoG gene from Bartonella spp. of blood samples, before and after incubation in pre-enrichment liquid medium (BAPGM) and isolation on chocolate agar, showed a positivity frequency of 42% (42/100) for Bartonella spp. Twelve B. henselae isolates obtained on agar chocolate from six cats’ blood samples (two isolates from each animal) were characterized by Multi-locus Sequencing Typing (MLST) and revealed to belong to Sequence Types ST1 and ST5. One of the cats (1/6) presented both STs, demonstrating that domestic cats can be coinfected with different variants of B. henselae. The STs detected in this study are distributed worldwide and have already been detected in humans with clinical manifestations of bartonellosis. This is the first report of the zoonotic variants ST1 and ST5 of B. henselae in domestic cats from Brazil.

LBSAT63 Cushing Syndrome As A Presentation Of Adrenocortical Carcinoma.Case Report

Abstract Introduction adrenocortical carcinoma is a rare endocrine malignancy (1) Case: 44 year old afro American female with no past medical history. No regular medications. Amenorrhea for 2 years. smokes cigarettes. Irrelevant family history. She presented with itchiness after cat scratch and was found to have hypertension urgency 229/123. Review of systems was positive for weight gain and easy bruises. Physical examination alert and oriented with body mass index of 31 kg/m2 heart rate 75 beats per minute normal heart sounds and clear lungs with scratch marks on left hand. bilateral lower extremities pitting edema, supraclavicular fat pad and violet abdominal striae. No facial plethora or hirsutism or lymphadenopathy or acne. Laboratory work up was remarkable for hypokalemia and metabolic alkalosis. High plasma morning cortisol level 53.6ug/dl normal between 6.2 and 29, 24hour urine cortisol and DHEAS and low ACTH FSH and LH. Estradiol 261pg/ml 17hydroxyprogesterone 49ng/dl and prolactin 31.7ng/ml. HBA1C 6.7. Normal renin aldosterone TSH and plasma and 24hour metanephrine and normetanephrine. Normal creatinine liver function and complete blood count. CT abdomen and pelvis with contrast showed large lobular heterogeneously enhancing mass in the left adrenal gland of 9. 0×10.1×10.1cm with left kidney posterior displacement and left renal vein compression. The pancreatic tail and splenic vein were draped over the mass. The right adrenal gland and other abdominal organs were unremarkable. DEXA scan showed osteopenia. CT chest showed 5mm right lower lobe nodule and compression fracture in the 7th thoracic vertebrae. Echocardiogram showed dilated left ventricle dimension with reduced ejection fraction 45%. The diagnosis was made for ACTH independent Cushing syndrome with adrenal mass. She underwent open left adrenalectomy distal pancreatectomy splenectomy and left nephrectomy in another institution. Histopathology showed 12×7.5×7 cm stage III adrenal cortical malignancy T3N0M0. Extensive necrosis and capsular invasion but negative surgical margins. Possibility of lung metastasis. Postoperative cortisol level 6. 02ug/dl. She was kept on postoperative slow tapering hydrocortisone with plan of chemotherapy and Mitotane. Conclusion adrenocortical carcinoma has a poor prognosis. It usually metastasizes to distant organs at time of diagnosis and rarely presents as Cushing syndrome. Surgical resection is the main management of localized tumors with controlling the effects of secreted hormones. Adjuvant therapies are chemotherapy radiotherapy and Mitotane according to the tumor stage and size. Mitotane is adrenal cytotoxic agent showed increase survival of advanced stages(1).

Cutaneous Anthrax After a Cat Scratch: A Case Report

Despite a global decline, Central Asia and Africa remain vulnerable to anthrax. Anthrax is usually caused by bacteria that enter the body through a wound from slaughtering sick animals. 95% of anthrax cases are skin-related. After 1 to 7 days, the spores in skin abrasion become vegetative. We present a 42-year-old woman with a cat scratch history who had small itchy blisters and swelling around a painless skin ulcer with a black core, low-grade fever, and hypotension. She had anemia, hypotension, and bilateral lower limb ulcers. Wound culture showed gram-positive bacilli compatible with B. anthracis. Blood transfusion, Ciprofloxacin 200mg/100ml twice daily, Meropenem 1g three times daily, and Clindamycin 600mg three times daily was given. Her amputated gangrene-infected finger helped her recover. Early diagnosis, antibiotic therapy, and preventive measures like immunization help control epidemics. This sporadic case of cutaneous anthrax alerts physicians.

A Rare Presentation of Second Branchial Cleft Cysts in Adult Patient: Case Report with Literature Review

Second branchial cleft cysts are the most common type of branchial cleft cysts as they make up approximately 95% of all cases. These are congenital conditions that occur in the upper lateral neck just anterior to the sternocleidomastoid muscle and caused by fluids filling spaces during early embryonic development. We present a case of atypical presentation of second branchial cleft cysts in 40 year’s patient, A surgical intervention was performed with complete excision of the cysts. Many of branchial cleft cysts would go unnoticed. However, upper respiratory tract infection can cause a sudden and significant increase in the size of the cyst because of the lymphoid tissue beneath the epithelium, The Differential diagnosis would include lymphadenopathy, lipoma, nerve sheath tumor, inflammatory lesions, carotid body tumor, external laryngocele, cystic hygroma, metastatic squamous cell carcinoma, tuberculosis-related, HIV-related lymphadenopathy, sarcoidosis, cat-scratch disease, lymphoma, and papillary thyroid carcinoma metastasis. Surgical excision is the only known treatment for second branchial cleft cysts; moreover, a complete removal of second bronchial cyst cleft is of paramount importance since it is key to preventing any recurrence of the disease.

A Rare Presentation of Cat-Scratch Disease: A Case Report with Neuroretinitis and Review of Cases Reported from Turkey

Neuroretinitis is a rare presentation of cat-scratch disease caused by Bartonella henselae. In this case report, we aimed to describe a 46-year-old male patient who presented with acute visual loss and was diagnosed as neuroretinitis. Fundus examination showed evidence of optic disc edema, macular star, and peripapillary hemorrhagia. The serological tests were positive for Bartonella with both IgM and IgG titers as 1/320. He was successfully treated with doxycycline for eight weeks. Both clinical and serological improvements were observed during the follow-up. Keywords : neuroretinitis, Bartonella henselae, cat-scratch diseases

Adhesion of Bartonella henselae to Fibronectin Is Mediated via Repetitive Motifs Present in the Stalk of Bartonella Adhesin A.

ABSTRACTAdhesion to host cells is the first and most crucial step in infections with pathogenic Gram-negative bacteria and is often mediated by trimeric autotransporter adhesins (TAAs). Bartonella henselae targets the extracellular matrix glycoprotein fibronectin (Fn) via the Bartonella adhesin A (BadA) attaching the bacteria to the host cell. The TAA BadA is characterized by a highly repetitive passenger domain consisting of 30 neck/stalk domains with various degrees of similarity. To elucidate the motif sequences mediating Fn binding, we generated 10 modified BadA constructs and verified their expression via Western blotting, confocal laser scanning, and electron microscopy. We analyzed their ability to bind human plasma Fn using quantitative whole-cell enzyme-linked immunosorbent assays (ELISAs) and fluorescence microscopy. Polyclonal antibodies targeting a 15-mer amino acid motif sequence proved to reduce Fn binding. We suggest that BadA adheres to Fn in a cumulative effort with quick saturation primarily via unpaired β-strands appearing in motifs repeatedly present throughout the neck/stalk region. In addition, we demonstrated that the length of truncated BadA constructs correlates with the immunoreactivity of human patient sera. The identification of BadA-Fn binding regions will support the development of new “antiadhesive” compounds inhibiting the initial adherence of B. henselae and other TAA-expressing pathogens to host cells.IMPORTANCE Trimeric autotransporter adhesins (TAAs) are important virulence factors and are widely present in various pathogenic Gram-negative bacteria. TAA-expressing bacteria cause a wide spectrum of human diseases, such as cat scratch disease (Bartonella henselae), enterocolitis (Yersinia enterocolitica), meningitis (Neisseria meningitis), and bloodstream infections (multidrug-resistant Acinetobacter baumannii). TAA-targeted antiadhesive strategies (against, e.g., Bartonella adhesin A [BadA], Yersinia adhesin A [YadA], Neisseria adhesin A [NadA], and Acinetobacter trimeric autotransporter [Ata]) might represent a universal strategy to counteract such bacterial infections. BadA is one of the best characterized TAAs, and because of its high number of (sub)domains, it serves as an attractive adhesin to study the domain-function relationship of TAAs in the infection process. The identification of common binding motifs between TAAs (here, BadA) and their major binding partner (here, fibronectin) provides a basis toward the design of novel “antiadhesive” compounds preventing the initial adherence of Gram-negative bacteria in infections.

Unwanted Scratching Behavior in Cats: Influence of Management Strategies and Cat and Owner Characteristics.

Simple SummaryCat scratching is a self-motivated and natural behavior, yet cat owners commonly report unwanted scratching on household items, such as furniture, walls, and carpets. This study explored the influence of owner management strategies, owner characteristics, and cat characteristics on the performance of unwanted scratching in the home. Perspectives of various intervention and management methods were collected using an online survey (n = 2465). Results reveal that owners generally agreed with providing additional appropriate surfaces and items for their cat to scratch rather than more permanent solutions, such as surrendering, euthanizing, or declawing. There were fewer reports of unwanted scratching for cat owners with older cats, and for those that provide enrichment items (e.g., sisal rope), outdoor access, positive reinforcement training, and restrict access to items they did not want scratched. Through this study, results suggest that cat owner interventions and management strategies can influence reports of unwanted scratching in cats and encourages the continued education to the public on effective options available.Despite scratching behavior in owned domestic cats being a self-motivated and natural behavior, it is commonly reported as a behavior problem by owners when it results in damage to household items. The objectives of this study were to use a cross-sectional survey targeting cat owners within the United States and Canada, to explore perspectives on cat scratching behavior and management strategies, as well as identify factors that influence the performance of inappropriate scratching behavior in the household. A total of 2465 cat owners participated in the survey and three mixed logistic regression models were generated to explore associations between (1) cat demographic factors, (2) provisions of enrichment, and (3) owner demographic and management factors with owner reports of problematic scratching. In this convenience sample, inappropriate scratching was reported by 58% of cat owners. Owner perspectives and management strategies aligned with current recommendations as they preferred to use appropriate surfaces (e.g., cat trees) and training to manage scratching as opposed to surrendering, euthanizing, or declawing. Logistic regression results found fewer reports of unwanted scratching behavior if owners provide enrichment (flat scratching surfaces (p = 0.037), sisal rope (p < 0.0001), and outdoor access (p = 0.01)), reward the use of appropriate scratching objects (p = 0.007), apply attractant to preferred items (p < 0.0001), restrict access to unwanted items (p < 0.0001), provide additional scratching posts (p < 0.0001), and if their cat is 7 years of age or older (p < 0.00001). Whereas if owners use verbal (p < 0.0001) or physical correction (p = 0.007) there were higher reports of unwanted scratching. Results suggest that damage to household items from scratching behavior is related to management strategies owners employ, and these findings can be used to support owner education in mitigation and prevention of inappropriate scratching.

Molecular detection and identification of Bartonella species in cats from Hamedan and Kermanshah, Western Iran

Bartonella species are emerging vector-borne zoonotic pathogens which infect a wide range of domestic and wild animals as well as humans. Cats are the primary reservoir hosts for several zoonotic Bartonella spp., the most common being B. henselae the causative agent of cat scratch disease. Despite the important role of cats in the epidemiology of bartonellosis, there is limited information about the prevalence and species infecting cats in Iran. The aim of present study was molecular detection and identification of Bartonella species in cats from two western provinces Hamedan and Kermanshah. From December 2018 to February 2021, 87 cats (n = 26 from Hamedan, n = 61 from Kermanshah) were examined clinically, their bodies were searched for collection of ectoparasites, and cephalic or saphenous blood specimens were collected. Genomic DNA was extracted from blood specimens and conventional PCRs targeting the rpoB, and ITS regions of Bartonella spp. were performed. Positive samples were sequenced and analysed phylogenetically. Bartonella DNA was detected in 11/87 cats (12.64 %). Sequencing results revealed the presence of B. henselae in cats from Hamedan, and B. clarridgeiae and B. henselae in cats from Kermanshah. A statistical association between cat origin and the prevalence of Bartonella spp. was observed in the studied population. This study confirms for the first time the circulation of Bartonella spp. in cats in two western Iranian provinces. Prevention strategies e.g. ectoparasites control, and regular examination of pet and urban cats are suggested for minimising Bartonella infection in cats and subsequently in humans.

Clinical utility of indirect fluorescent assay for IgA class antibodies against Bartonella henselae in serodiagnosis of cat scratch disease in its early stage

The utility of IgA class antibodies for the serodiagnosis of cat scratch disease (CSD) was evaluated by developing an indirect immunofluorescent assay (IFA) using an antigen obtained by co-cultivating Bartonella henselae ATCC 49882 with Vero cells. Served for evaluation were 101 sera from patients serologically confirmed as CSD with IgG-IFA ≥1:256, and 144 sera from patients clinically suspected of CSD but not serologically confirmed. The sensitivity of the newly developed IgA-IFA in detecting the confirmed cases was 57.4% (58/101), and 75.0% in combination with IgM-IFA. As for the non-confirmed cases, IgA-IFA turned 8.3% cases (12/144) positive, 10 of whom were subsequently diagnosed as CSD of early stage from clinical courses and/or by repeated testing. The 12-case gain was regarded as a significant improvement. Hence, the diagnostic rate of early-stage CSD is expected to be increased by routinely performing IgA-IFA in addition to conventional IgG/IgM-IFA.

Molecular prevalence and genetic diversity of Bartonella spp. in stray cats of İzmir, Turkey

BackgroundBartonella spp. are vector-borne pathogens that cause zoonotic infections in humans. One of the most well-known of these is cat-scratch disease caused by Bartonella henselae and Bartonella clarridgeiae, with cats being the major reservoir for these two bacteria. Izmir, Turkey is home to many stray cats, but their potential role as a reservoir for the transmission of Bartonella to humans has not been investigated yet. Therefore, the aim of this study was to investigate the prevalence of Bartonella species and their genetic diversity in stray cats living in Izmir.MethodsMolecular prevalence of Bartonella spp. in stray cats (n = 1012) was investigated using a PCR method targeting the 16S-23S internal transcribed spacer gene (ITS), species identification was performed by sequencing and genetic diversity was evaluated by haplotype analysis.ResultsAnalysis of the DNA extracted from 1012 blood samples collected from stray cats revealed that 122 samples were Bartonella-positive, which is a molecular prevalence of 12.05% (122/1012; 95% confidence interval [CI] 10.1–14.2%). Among the Bartonella-positive specimens, 100 (100/122; 81.96%) were successfully sequenced, and B. henselae (45/100; 45%), B. clarridgeiae (29/100; 29%) and Bartonella koehlerae (26/100; 26%) were identified by BLAST and phylogenetic analyses. High genetic diversity was detected in B. clarridgeiae with 19 haplotypes, followed by B. henselae (14 haplotypes) and B. koehlerae (8 haplotypes).ConclusionsThis comprehensive study analyzing a large number of samples collected from stray cats showed that Bartonella species are an important source of infection to humans living in Izmir. In addition, high genetic diversity was detected within each Bartonella species.

Hepatic Lesions in an Immunocompetent Child Previously Treated for Cat Scratch Disease With Azithromycin.

Hepatic Lesions in an Immunocompetent Child Previously Treated for Cat Scratch Disease With Azithromycin.

Cat-scratch disease, ¿does it always present with lymphadenopathy?: A case report

Cat-scratch disease (CSD) is a zoonotic disease, caused by Bartonella henselae, a gram-negative bacillus, that has a variable clinical presentation and must be suspected in immunocompetent patients or immunocompromised patients with prolonged febrile syndrome of unknown origin that have history of interaction with cats. Diagnosing CSD may be challenging, so clinical suspicion and a thorough clinical interview and workup are essential to come up with a definitive conclusion. Typically, CSD presents with regional lymphadenopathies and subsequent systemic compromise. However, it can present with a unique manifestation such as hepatosplenic compromise. Herein, we present a patient with prolonged febrile syndrome with systemic symptoms and reticuloendothelial compromise.

Cat Scratch Disease: 9 Years of Experience at a Pediatric Center.

BackgroundA more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care.MethodsWe conducted a retrospective analysis of children presenting to a tertiary pediatric hospital system in Atlanta, Georgia between January 1, 2010 and December 31, 2018 who had serology, polymerase chain reaction, and/or cytopathological results consistent with a Bartonella henselae infection. We also retrospectively reviewed veterinary diagnostic results performed at the University of Georgia from 2018 to 2020 to ascertain the burden of bartonellosis in companion animals within the state.ResultsWe identified 304 children with CSD over 9 years with the largest proportion of diagnoses made during August (41 of 304, 13.5%) and September (47 of 304, 15.5%). The median age of child cases was 8.1 years (interquartile range [IQR], 5.4–12.1); 156 (51.3%) were female; 242 of 262 (92.4%) reported feline exposure; and 55 of 250 (22%) reported canine exposure of those with exposure histories documented in the medical record. Although lymphadenopathy was present on physical examination in the majority of cases (78.8%), atypical presentations lacking lymphadenopathy were also common (63 of 304, 20.7%). Among children with radiographic imaging, 20 of 55 (36.4%) had splenomegaly and 21 of 55 (38.1%) had splenic and/or hepatic microabscesses. Among veterinary data, Bartonella seroprevalence was 12 of 146 (8.2%), all among canines, with a geographic distribution that spanned the state of Georgia.ConclusionsDistinguishing clinical features of CSD included subacute regional lymphadenopathy in school-aged children in the late summer, almost all of whom had cat exposure. Atypical clinical manifestations of CSD were also commonly identified.

Cute Cats, Disastrous Nightmare

Abstract We reported a rare case of neuroretinitis secondary to cat scratch disease, which was successfully treated with steroids and antibiotic. A healthy young lady presented with a 6-day history of central blurring of vision over her right eye (OD) after an episode of flu. Visual acuity over the OD was 6/60 with positive relative afferent pupillary defect. There were no features of anterior uveitis. Fundus of the OD showed swollen, hyperemic optic disc with disc hemorrhages and early macular star but clear vitreous, with the absence of retinochoroiditis or vasculitic changes. The serum Bartonella henselae immunoglobulins M and G were raised. Magnetic resonance imaging of the brain and orbit showed a normal result. Our impression was neuroretinitis secondary to cat scratch disease. Her OD’s vision improved to 6/9 after completing a course of doxycycline and systemic corticosteroids. Early commencement of antibiotic and corticosteroids is essential to impede potentially blinding ocular complications despite its rarity.

Serological review of Bartonella henselae and Bartonella quintana infection among Malaysian patients with unknown causes of febrile illnesses.

Limited information is available on human exposure to Bartonella infection, i.e., Bartonella henselae (causative agent of cat scratch disease) and Bartonella quintana (causative agent of trench fever) in West Malaysia. This study reports a review of serological findings obtained from patients attending to a teaching hospital in Klang Valley, Malaysia. An indirect immunofluorescence assay (IFA) was used to determine IgG and IgM antibody titers against B. henselae and B. quintana. In a pilot study conducted between 2013-2015, IgG antibodies against Bartonella spp. (either B. quintana and B. henselae) were detected in 14 (36.8%) of 38 patients who were clinically suspected of rickettsial infections, while IgM antibody was detected in 4 (10.5%) patients. This has prompted us to investigate the serologic responses of patients who were clinically suspected of other febrile causes besides rickettsial infection. Of the 59 serum samples analysed in a follow-up investigation, Bartonella IgG antibodies were detected from 7 (11.9%) patients, of which 5 (27.8%) and 2 (18.2%) patients were clinically suspected of rickettsial infection (n=18) and dengue (n=11), respectively. None of the sera obtained from the leptospirosis (n=10), legionellosis (n=10) and mycoplasma infection (n=10) groups were seropositive to Bartonella spp. The review of Bartonella serological findings in this study highlights that Bartonella infection is not uncommon and should be considered as one of the causes for febrile illness in Malaysia.

Parinaud's oculo-glandular syndrome secondary to sporotrichosis

Parinaud's oculoglandular syndrome (PCOS) is a rare eye disease caused by different etiological agents, including bacteria, viruses and fungi. PCOS is a special form of granulomatous conjunctivitis and is often associated with cat scratch disease, herpes simplex infection, sporotrichosis, blastomycosis, and coccidioidomycosis. Sporotrichosis is a subcutaneous mycosis caused by the fungus Sporothrix schenckii with global distribution and, in general, patients are treated on an outpatient basis. Since 1998, there has been an increase in cases in the State of Rio de Janeiro, Brazil, especially due to zoonotic transmission involving cats. PCOS is characterized by granulomatous conjunctivitis accompanied by adjacent pre-auricular lymphadenopathy and systemic symptoms such as sweating, feeling sick, and fever. Complementary tests including culture confirm the diagnosis of sporotrichosis. Its classic clinical presentation should always be remembered by specialists so that the correct diagnosis and treatment with antifungal agents is carried out early, so that the condition can be resolved without sequelae for the patients.

A clinical case of the development of a rare manifestation of cat scratch disease

Introduction. Cat scratch disease is a common infectious disease caused by intracellular microorganisms Bartonella henselae, which are widespread among wild and domestic animals. The aim of study was to demonstrate a rare clinical case of chorioretinitis against the background of a 10-year-old child’s bartonellosis. Materials and methods. A 10-year-old child received with complaints about a significant decrease of vision and lowering of the upper eyelid of the left eye. The disease began with increase in temperature to 37.5 °C, abdominal pain. Three days later, these ophthalmic complaints appeared. After examining a paediatric ophthalmologist, neurologist and conducting an additional instrumental survey, the patient was hospitalised in an ophthalmological hospital. When acuity of vision of the left eye was 0.02 n/a, the upper eyelid was lowered. On the fundus there was a pronounced extensive edema of the optic nerve disc (OND) with prominance, from OND to the macular zone there was an extensive high retinal swelling. The department conducted a standard clinical examination, blood test for chronic infections, examination of visual evoked potentials and other instrumental examinations. From the first day, local and general antibacterial and anti-inflammatory treatment was carried out. Results and Discussion. Positive dynamics has been observed since the fourth day of treatment, but the visual acuity of the left eye has not improved. On the eighth day, the patient was discharged for subsequent hospitalisation at the Federal State Budgetary Institution NMRC of Eye Diseases named after Helmholtz, in which he was examined for bartonellosis and identified IgG to Bartonella henselae 1:160. Final clinical diagnosed: Left eye neuroretinitis associated with bartonellosis. On the fourteenth day after treatment, the patient was discharged - the left eye was almost calm, visual acuity was 0.06. In this clinical case, a rare manifestation of cat scratches disease is described. Due to the late visit to an ophthalmologist and the late start of medical treatment, it was not possible to fully restore the vision of the left eye. Conclusion. In most cases, it takes a lot of time to make a diagnosis, and specific treatment begins late, in connection with which it is necessary to draw attention to this problem of doctors of different directions. It should also be remembered that any atypical manifestation of the disease serves as a reason to exclude rickettsiosis, including bartonellosis.

Parinaud's oculoglandular syndrome

Parinaud's oculoglandular syndrome (POGS) is a rare condition characterized by unilateral granulomatous conjunctivitis and ipsilateral regional lymphadenopathy. Among all infectious agents, cat scratch disease (CSD), which is caused by Bartonella henselae, remains the commonest etiology agent of POGS. We present a case report of a 13-year-old boy who came to a tertiary center in Malaysia with left granulomatous conjunctivitis and subsequent necrotizing lesions involving left upper eyelid, left paranasal region, and left preauricular lymph nodes. With a poor initial treatment response and confusing investigation results, this interesting case describes the diagnostic dilemma in differentiating the etiological agents of POGS.

Into the unknown: Diagnosing mysterious brain lesions.

In this inaugural clinicopathological conference, the invited experts discussed the diagnostic approach to central nervous system infections in immunocompromised hosts. The case presented involved a pancreas-kidney transplant recipient with multiple brain abscesses caused by Bartonella henselae. CSF metagenomic next-generation sequencing played a significant role in the diagnosis. Bartonella henselae is a gram-negative zoonotic pathogen that causes cat-scratch disease, which can be transmitted to humans through cat bites or scratches. Symptoms can vary in severity, correlating with the patient's immune status. Visceral organ involvement, ocular involvement, and neurological manifestations have been reported in immunocompromised patients, but brain abscesses are rare.