Posters
Presenting Author Academic/Professional Position
Medical Student
Academic Level (Author 1)
Medical Student
Academic Level (Author 2)
Medical Student
Academic Level (Author 3)
Medical Student
Discipline/Specialty (Author 4)
Pediatrics
Academic Level (Author 5)
Faculty
Discipline/Specialty (Author 5)
Pediatrics
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Research/Clinical
Abstract
Background: Skin lesions and/or regional lymphadenopathy are defining characteristics of Cat Scratch Disease (CSD), a zoonotic infection commonly caused by animals carrying Bartonella henselae. While CSD is often self-limiting, rare cases with a disseminated course and visceral organ involvement may complicate diagnosis, especially in pediatric patients. This case report describes an atypical presentation of B. henselae infection in an 11-year-old female with Type I diabetes (T1D).
Case Presentation: An 11-year-old girl with a history of T1D presented to her pediatrician with abdominal pain and fever. A rapid test confirmed Streptococcal Pharyngitis and she was prescribed amoxicillin and sent home. Despite treatment, her symptoms persisted, including fever (Tmax: 102°F), body aches, and chills. On Day 3, she visited the emergency department (ED), where repeat tests again confirmed Streptococcal infection. She was advised to continue the previously prescribed antibiotics. On Day 4, the patient returned to the ED with worsening right upper quadrant (RUQ) abdominal pain. During the visit, she disclosed playing with cats, including stray cats that wander into her yard. A CT scan of the chest and abdomen, ordered to evaluate for appendicitis, revealed multiple cystic lesions in the liver, raising concern for malignancy. The patient was admitted for further evaluation and management. On physical examination, the patient exhibited persistent fever and mild respiratory symptoms. She denied gastrointestinal complaints and showed no palpable lymphadenopathy or hepatomegaly. Laboratory findings showed hemoglobin of 9 g/dL (normal range: 11.9 - 14.8 g/dL), platelets of 179 x 109/L (normal range: 177 - 381 x 109/L), elevated erythrocyte sedimentation rate (ESR) at 66 mm/hr (normal range: 0 - 10 mm/hr), and C-reactive protein of 7.7 mg/L (normal range:B. henselae infection, confirming disseminated CSD.
Conclusion: CSD can uncommonly present in challenging ways, leading to a prolonged and complex disease course. Disseminated disease is a serious complication of B. henselae. Apart from hepatic involvement, other rare presentations may include Parinaud oculoglandular syndrome or Neuroretinitis. Immunocompromised individuals, such as those with diabetes, are at increased risk for atypical disease presentations. Notably, the prevalence of diabetes in the Rio Grande Valley exceeds the national average, highlighting the need for clinicians to maintain a high index of suspicion for atypical manifestations that may complicate outcomes in this population.
Recommended Citation
Bonilla, Paul; Pulido, Kassandra; Bell, Natasha; and Velasquez, Otto, "Atypical Presentation of Pediatric Cat Scratch Disease: A Case Report" (2025). Research Symposium. 126.
https://scholarworks.utrgv.edu/somrs/2025/posters/126
Included in
Atypical Presentation of Pediatric Cat Scratch Disease: A Case Report
Background: Skin lesions and/or regional lymphadenopathy are defining characteristics of Cat Scratch Disease (CSD), a zoonotic infection commonly caused by animals carrying Bartonella henselae. While CSD is often self-limiting, rare cases with a disseminated course and visceral organ involvement may complicate diagnosis, especially in pediatric patients. This case report describes an atypical presentation of B. henselae infection in an 11-year-old female with Type I diabetes (T1D).
Case Presentation: An 11-year-old girl with a history of T1D presented to her pediatrician with abdominal pain and fever. A rapid test confirmed Streptococcal Pharyngitis and she was prescribed amoxicillin and sent home. Despite treatment, her symptoms persisted, including fever (Tmax: 102°F), body aches, and chills. On Day 3, she visited the emergency department (ED), where repeat tests again confirmed Streptococcal infection. She was advised to continue the previously prescribed antibiotics. On Day 4, the patient returned to the ED with worsening right upper quadrant (RUQ) abdominal pain. During the visit, she disclosed playing with cats, including stray cats that wander into her yard. A CT scan of the chest and abdomen, ordered to evaluate for appendicitis, revealed multiple cystic lesions in the liver, raising concern for malignancy. The patient was admitted for further evaluation and management. On physical examination, the patient exhibited persistent fever and mild respiratory symptoms. She denied gastrointestinal complaints and showed no palpable lymphadenopathy or hepatomegaly. Laboratory findings showed hemoglobin of 9 g/dL (normal range: 11.9 - 14.8 g/dL), platelets of 179 x 109/L (normal range: 177 - 381 x 109/L), elevated erythrocyte sedimentation rate (ESR) at 66 mm/hr (normal range: 0 - 10 mm/hr), and C-reactive protein of 7.7 mg/L (normal range:B. henselae infection, confirming disseminated CSD.
Conclusion: CSD can uncommonly present in challenging ways, leading to a prolonged and complex disease course. Disseminated disease is a serious complication of B. henselae. Apart from hepatic involvement, other rare presentations may include Parinaud oculoglandular syndrome or Neuroretinitis. Immunocompromised individuals, such as those with diabetes, are at increased risk for atypical disease presentations. Notably, the prevalence of diabetes in the Rio Grande Valley exceeds the national average, highlighting the need for clinicians to maintain a high index of suspicion for atypical manifestations that may complicate outcomes in this population.
