A cat scratch caused splenic necrosis in an immunocompromised woman.
A 29-year-old woman came to a clinic in Germany with persistent fever that did not respond to empiric treatment. Five years earlier she had undergone a kidney transplant; She was taking immunosuppressive drugs (tacrolimus, mycophenolate mofetil, methylprednisolone).
On examination, a healing cat scratch was noted on the medial part of the right thigh. T1-weighted MRI of the abdomen shows an enlarged spleen with variable areas in the liver and spleen. Serology: Antibodies to Bartonella henselae. IgM 1:192 (reference less than 1:12), IgG 1:64 (reference less than 1:64), PCR negative in serum. Azithromycin and rifampicin were administered on suspicion of bartonolosis.
To rule out lymphoma, a spleen biopsy was performed, which was complicated by bleeding, followed by a splenectomy. Macroscopically, whitish nodes were found in the spleen; Histology - necrotic granulomas. Tissue PCR positive for B. henselae.
Diagnosis: Disseminated bartonolosis (cat scratch disease, palinosis) is an infection transmitted by cats and less commonly by other animals. Regional lymph nodes are usually affected, but due to immunosuppression, the process can involve the liver and spleen. Six weeks after the end of treatment, the patient's condition returned to normal.
New England Journal of Medicine.