Abstract
A patient complaining of swelling and tenderness in her left axilla was diagnosed with cat scratch disease despite no apparent history of cat exposure. Zoonosis can occur even in the absence of cat exposure because cat flea Ctenocephalides felis is also the vector of the pathogen through the flea feces.
Keywords: cat scratch disease, lymphadenopathy and subcutaneous abscess
A patient complaining of swelling and tenderness in her left axilla was diagnosed with cat scratch disease despite no apparent history of cat exposure. Zoonosis can occur even in the absence of cat exposure because cat flea Ctenocephalides felis is also the vector of the pathogen through the flea feces.
A 52‐year‐old woman with no history of a cat scratch complained of swelling and tenderness in her left axilla that deteriorated over a month (Figure 1A). Enhanced computed tomography revealed a lymphadenopathy (Figure 1B, arrowhead) and a subcutaneous abscess measuring 4 cm (Figure 1B, arrow). Although she had no apparent history of cat exposure, she was diagnosed with cat scratch disease because serum Bartonella henselae IgG titer was highly elevated (1:512; normal range, <1:64). Drainage for the subcutaneous abscess and administration of oral minocycline and levofloxacin improved the lesion.
FIGURE 1.
(A) Shows an axillary image. (B) Shows a contrast‐enhanced CT image
In general, cat scratch disease is caused by scratch or bite from a cat infected with Bartonella species. However, it can occur without a cat exposure because cat flea Ctenocephalides felis is also the vector of the pathogen through the flea feces. 1 In addition to fleas, there are other known and suspected modes of Bartonella species transmission. 2 When a patient manifest with single axilla lymphadenopathy, the zoonosis should be kept in mind even in the absence of precedent cat exposure.
CONFLICT OF INTEREST
None declared.
AUTHOR CONTRIBUTIONS
KO: wrote the first draft and managed all the submission process. YT and HH: contributed to the clinical management of the patient. FO: organized writing the manuscript.
CONSENT
Written informed consent was obtained from the patient to publish this case report.
ACKNOWLEDGMENT
None.
Oka K, Takagi Y, Hagiya H, Otsuka F. Cat scratch disease without a history of cat exposure. Clin Case Rep.2022;10:e04816. 10.1002/ccr3.4816
DATA AVAILABILITY STATEMENT
Not applicable.
REFERENCES
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Associated Data
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Data Availability Statement
Not applicable.