1- Unidade de Infecciologia Pediátrica. Área de Pediatria Médica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa
ESPID 2016 - Paediatric Infectious Diseases Meeting, apresentação sob a forma de poster
Introduction Inguinal lymphadenopathies during adolescence are usually due to neoplastic disorders or infectious diseases (originated by streptococcus, cytomegalovirus, Epstein-Barr, toxoplasma, HIV and mycobacterium). But other possible etiologies should be considered.
Clinical case We report an 11-years-old girl with history of a painful inguinal mass with progressive growth without inflammatory signs or fever. As a result of lack of improvement with oral flucloxacillin, she became hospitalized to do endovenous antibiotherapy (flucloxacillin plus clindamycin) and for further investigation. Laboratory tests revealed acute-phase reactants lightly elevated without leucocytosis (WBC 8700, c-reactive protein 7,2 mg/L; sedimentation rate 45 mm/h) and ultrasound exam showed “inguinal mass (3cm x 2cm) with a liquefied area associated with inflammation of subcutaneous tissue, compatible with an adenophlegmon”. Infection causes, such as, streptococcus, cytomegalovirus, Epstein-Barr virus, toxoplasma and mycobacterium tuberculosis, have been excluded and microbiological analysis of surgery resection was negative. Besides negative history of animal contact, bartonella serology was positive and the patient was treated with azytromycin. After a more detailed anamnesis it was possible to identify the contact with a friend’s cat, which was also treated.
Conclusion Cat-Scratch Disease (CSD) is a relatively common zoonosis, whose incidence in Portugal is probably underestimated. It is mainly characterized by self-limiting lymphadenopathy in the draining site of a cat scratch or bite. CSD should always be considered when there is no adenitis improvement with antibiotherapy correctly instituted, even if there is no epidemiologic context.
Palavras Chave: Lymphadenopathy / Inguinal Mass / Adolescent / Bartonella / Cat-Scratch Disease