title: Cat scratch disease causing hepatic masses after liver transplant.
abstract: Hepatic cat scratch disease is rarely reported in liver transplant recipients and has never been reported with discrete liver lesions in the graft. A 52-year-old woman was transplanted for hepatitis C cirrhosis and hepatocellular carcinoma. Her posttransplant course was uneventful. She presented 2.7 years after transplantation with fever of unknown origin and went on to develop multiple and diffuse discrete liver lesions. Despite an extensive work-up including percutaneous and laparoscopic biopsies, a subsegmental resection that included one of these masses was required to make the diagnosis of Bartonella henselae infection. Serologic tests were equivocal. Histology was consistent with cat scratch disease of the liver, and polymerase chain reaction (PCR) testing of the resected tissue confirmed the diagnosis. Response to doxycycline was rapid. Fevers resolved within 7 days. Repeat abdominal CT scan showed reduction of the liver masses. Cat scratch disease should be considered in postliver transplant patients presenting with fever and liver lesions, especially if close contact with cats has occurred. Diagnosis by PCR testing of involved tissue is preferred when serologies are equivocal due to immunosuppression.
authors.affiliation: Gastroenterology and Hepatology Division, Department of Internal Medicine, Saint Louis University Hospital, St Louis, MO, USA.
authors.forename: Kavitha R
authors.initials: KR
authors.lastname: Thudi
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Kreikemeier
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Phillips
authors.forename: Paolo R
authors.initials: PR
authors.lastname: Salvalaggio
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Kennedy
authors.forename: Paul H
authors.initials: PH
authors.lastname: Hayashi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002372:Cat-Scratch Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D016031:Liver Transplantation; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline