Atteinte hépatosplénique de la maladie des griffes du chat : à propos de deux observations chez l'immunocompétent

Hepatosplenic cat scratch disease in immunocompetent adults: report of 3 cases and review of the literature

Cat-scratch disease (CSD) is the most frequent presentation of Bartonella henselae infection. It has a worldwide distribution and is associated with a previous history of scratch or bite from a cat or dog. CSD affects children and teenagers more often (80%) than adults, and it usually has a self-limiting clinical course. Atypical clinical course or systemic symptoms are described in 5%-20% of patients. Among them, hepatosplenic (HS) forms (abscess) have been described. The majority of published cases have affected children or immunosuppressed patients. Few cases of HS forms of CSD in immunocompetent adult hosts have been reported, and data about the management of this condition are scarce. Herein, we present 3 new cases of HS forms of CSD in immunocompetent adults and review 33 other cases retrieved from the literature. We propose an approach to clinical diagnosis and treatment with oral azithromycin.

Visceral cat scratch disease with endocarditis in an immunocompetent adult: a case report and review of the literature

Infective endocarditis and hepatosplenic abscesses are rare manifestations of cat scratch disease (CSD), especially among immunocompetent adults. An otherwise healthy woman who presented with fever and abdominal pain was diagnosed with multiple abscesses in the spleen and the liver, as well as a mitral valve vegetation. PCR on spleen tissue was positive for Bartonella henselae. Prolonged treatment with doxycycline and gentamicin led to complete recovery. Review of the literature revealed 18 cases of hepatosplenic CSD in immunocompetent adults; the majority presented with fever of unknown origin and abdominal pain. In most cases the causative organism was B. henselae and the pathological findings were necrotizing granulomas, similar to the pathological features in classic CSD. Concomitant endocarditis was diagnosed in one case. Because Bartonella is one of the leading pathogens of culture-negative endocarditis, we raise the question of whether a comprehensive evaluation for endocarditis is needed in cases of systemic CSD.

Diagnosis and follow-up of Bartonella henselae infection in the spleen of an immunocompetent patient by real-time quantitative PCR

Systemic Bartonella henselae infections are unusual in immunocompetent adults. However, here we report one such case of bartonellosis in a 34-year-old patient, who presented with fever and multinodular splenomegaly. We also describe a novel method of identifying Bartonella henselae by real-time quantitative polymerase chain reaction and sequencing of amplified products. This could prevent splenic bartonellosis being mistaken for lymphoma and thereby avert unnecessary splenectomy.

Systemic Bartonella henselae Infection in Immunocompetent Adult Presenting as Fever of Unknown Origin

Systemic clinical presentations of infection caused by Bartonella henselae are rare in immunocompetent adults. We report four cases with hepatic and/or splenic involvement, presenting as fever of unknown origin. We discuss diagnosis and treatment of this infection. Bartonella henselae serology allows an easy diagnosis of hepatosplenic involvement in cat scratch disease, a clinical picture that appears to be underrecognized.