Cat scratch disease

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Cat scratch disease, also cat scratch fever, is an uncommon pathology of the lymph node.

Cat scratch disease
Diagnosis in short

Cat scratch disease. H&E stain.
LM necrotizing granulomas with neutrophils and star-shaped (stellate, +/-multinucleated giant cells, microorganisms consistent with B. henselae
LM DDx sporotrichosis, lymphogranuloma venereum, tularemia
Stains Warthin-Starry stain +ve
IHC B. henselae +ve
Site lymph node - see lymph node pathology
Clinical history contact with cats
Signs fever, lymphadenopathy
Prevalence rare
Prognosis benign
Clin. DDx other causes of lymphadenopathy, e.g. lymphoma

General

  • Infection caused Bartonella henselae,[1] a gram-negative bacillus (0.3-1.0 x 0.6-3.0 micrometers) in chains, clumps, or singular.[2]
  • Treatment: antibiotics.

Clinical

Features:[3]

  • Usually unilateral.
    • May be disseminated in individuals with immune dysfunction.
  • Contact with cats.

Micrograph

Features:[3]

  • Necrotizing granulomas with:
    • Neutrophils present in microabscess (necrotic debris) - key feature.
      • Microabscesses often described as "stellate" (star-shaped).
  • +/-Multinucleated giant cells.
  • Microorganism consistent with B. henselae.

Notes:

  • May involve capsule or perinodal tissue.

DDx of stellate abscess in lymph nodes - cat split:[4]

Images

www:

  • CSD - very low mag. - showing serpentine shaped microabscesses (WC)

  • CSD - low mag. - showing serpentine shaped microabscesses (WC)

  • CSD - high mag. - showing neutrophilic abscesses (WC)

Stains

  • Warthin-Starry stain +ve -- bacilli.
  • Gram stain -ve.

IHC

  • B. henselae IHC stain +ve -- bacilli - diagnostic.

See also

References

  1. ↑ Jerris, RC.; Regnery, RL. (1996). "Will the real agent of cat-scratch disease please stand up?". Annu Rev Microbiol 50: 707-25. doi:10.1146/annurev.micro.50.1.707. PMID 8905096.
  2. ↑ Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 110. ISBN 978-0781775960.
  3. ↑ 3.0 3.1 Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 113. ISBN 978-0781775960.
  4. ↑ URL: http://www.dermpathmd.com/mnemonics/mnemonics_dermatopathology.htm. Accessed on: 23 September 2011.
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