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Title: Een jonge vrouw met necrotiserende granulomen in de lever
Author(s): RÖTGENS J, DEGROOTE H, HOORENS A, SMEETS A P
Journal: Tijdschrift voor Geneeskunde
Volume: 73    Issue: 5   Date: 2017   
Pages: 255-261
DOI: 10.2143/TVG.73.05.2002287

Abstract :
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An atypical presentation of cat scratch disease: a hepatic granulomatous infection
In this case report, a 27-year-old patient underwent a caesarean section at 37 weeks of pregnancy due to a breech presentation. Ten days later she went to the emergency department with fever and severe right upper quadrant pain. The blood tests identified an elevated C reactive protein (CRP) level and disturbed cholestatic liver enzymes. An MRI of the liver showed the presence of a hepatosplenome­galy and multiple liver abscesses. The anatomo­pathological study revealed numerous necrotising granulomas. All the pieces fall into place when serology turns out to be positive for Bartonella henselae.
In 10% of all cases, an infection with B. henselae gives rise to an atypical disseminated infection. Particularly ocular, neurologic and hepato­splenic involvement are described in literature. Contrary to a typical (local) cat scratch disease, a disseminated infection is always treated with antibiotics.


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