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TitleCat-scratch disease with systemic manifestations in children: role of fundus examination for pattern recognition/diagnosis
PurposeTo characterize two cases of cat-scratch disease (CSD) in children admitted to general hospital with fever of unknown origin (FUO), and for which fundus examination clinched diagnosis.
MethodsCase report
ResultsA 13-YO boy and a 10-YO girl were admitted to 2 different hospitals, with history of FUO. Extensive investigations were negative until ophthalmology consultation was requested. Because of acute abdominal pain suspicious of appendicitis, the girl had undergone videolaparoscopy, revealing micronodules of unknown etiology in liver/spleen. Fundus examination of the girl, who had visual acuity (VA) was 20/20 in both eyes (OU), revealed a picture consistent with multifocal retinitis, with multiple peripheral retina infiltrates in OU, a few of them with an angiomatoid aspect and leading to local lipid exudation. The boy had severe neuroretinitis in the right eye (with VA of counting fingers) and multifocal retinitis in the left eye (VA of 20/20); one of the peripheral retinal infiltrates was also angiomatoid. Both patients referred close contact with cats, the boy had an infiltrated wound in his hand from a recent cat scratch, and the girl had multiple scratches in the arms/legs. Treatment for CSD was then initiated, with azithromycin/rifampin, for the girl, and doxycycline/prednisone, for the boy, with resolution of intraocular inflammation.
ConclusionCSD may be associated with pronounced systemic symptoms in children with FUO. Investigation of close contact with cats and fundus examination may be useful, allowing prompt initiation of antibiotic therapy and rapid improvement, even before serological results are available.
Conflict of interestNo
Authors 1
Last nameBARBOSA
Initials of first name(s)AKP
Authors 2
Initials of first name(s)DV