Clinical Review Lesson of the week

Cat scratch disease

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7347.1199 (Published 18 May 2002) Cite this as: BMJ 2002;324:1199
  1. Alexander Williams, general practitioner (su1838@eclipse.co.uk)a,
  2. Christopher D Sheldon, consultant chest physicianb,
  3. Terry Riordan, consultant microbiologistc
  1. a St Thomas Health Centre, Exeter EX4 1HJ
  2. b Royal Devon and Exeter Hospital, Wonford, Exeter EX2 5DW
  3. c Public Health Laboratory, Royal Devon and Exeter Hospital
  1. Correspondence to: A Williams
  • Accepted 1 October 2001

Unilateral lymphadenopathy of the groin is commonly seen in general practice. We report on a patient with initial features suggestive of sarcoidosis, but who, after careful history taking and further investigation, had cat scratch disease.

Case report

A 29 year old woman visited her general practitioner with a painless swelling in the right groin. She was referred to a surgeon, who aspirated the node. The aspirate contained blood and a range of lymphoid cells, suggesting a reactive lymph node. Ultrasonography confirmed numerous large lymph nodes in the right groin. Lymphadenopathy was not present elsewhere. The pelvis appeared normal on ultrasonography. Two hypoechoic lesions were found in the right lobe of the liver posteriorly, and multiple similar lesions were found in the spleen, but no para-aortic lymphadenopathy was seen.

The surgeon took a biopsy specimen of the lymph node. This showed a reactive lymph node with prominent geminal centres and focal areas in keeping with necrotising granulomata. Cultures were Gram negative. Stains for acid fast bacilli and fungi gave negative results, and there was no evidence of caseating necrosis. Sarcoidosis was suspected, and the patient was referred to a chest physician.

She had no symptoms of systemic disease and had a good appetite, steady weight, and no night sweats. She had never smoked but did have several allergies, including eczema and perennial rhinitis. At initial presentation a full blood count gave normal …

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