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Joana Simões, Flora Candeias, Maria João Brito

Unidade de Infecciologia Pediátrica, Área de Pediatria Médica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa

- Reunião internacional – European Society of Pediatric Infectious Diseases 2016
- Publicação sob forma de resumo
- Publicação sob forma integral (e-poster)

Background: Fever of unknown origin is a diagnostic challenge in daily practice. Although most underlying causes are common, when atypical manifestations are present and the investigation doesn't lead to an obvious diagnosis, infrequent causes should be considered. 
Case Presentation Summary: Previously healthy 14 year-old boy presented with 4-week history of fever, weight loss of five kilos and night sweats. His immunization program was updated. He lived in a rural region, didn't consume unpasteurized dairy and had no recent travels. Physical examination revealed cervical and inguinal lymphadenopathy (1,2 cm) with no inflammatory signs, abdominal pain, left shoulder discomfort and upper left abdominal tenderness at palpation. Bloodwork showed haemoglobin 12,6 g/dL, 7,9x10^9/L leucocytes, 6,8% monocytes, 101 mm/h sedimentation rate and reactive C protein 139,2 mg/L, with no other abnormal results. Cervical echography ultrasound revealed accessory spinal and jugulocarotid lymphdenopathy with insuspect morphologic appearance and number, and no signs of absceded collections. At both abdominal ultrasound and CT scan, there was mild spleen enlargement with multiple hypoecogenic and hypodense infracentimetric lesions all over the splenic parenchyma, resembling micro-abscesses, Among other etiologic investigation, serologic testing was positive for Bartonella henselae. A 6-week treatment with rifampicin and ciprofloxacin resolved the fever and splenic nodules. Further enquiry revealed contact with an infected cat. 
Learning Points/Discussion: Splenic bartonellosis is an atypical, rare presentation of the cat-scratch disease (5-14%) and poses itself as an important cause of prolonged fever in children. Rare clinical forms as splenic bartonellosis may have a prolonged course and need antibiotic treatment. However, the prognosis of these frequently undersuspected presentations is typically good, so as the prognosis of common cat-scratch disease.

Palavras Chave: cat-scratch disease; fever; splenic bartonellosis