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Document Details :
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
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.