title: Expressive aphasia as a presentation of encephalitis with Bartonella henselae infection in an immunocompetent adult.
abstract: OBJECTIVE
  To show the first clinically reported case of Cat Scratch Disease (CSD) presenting as a focal neurologic deficit in an immunocompetent adult.
  
  
  METHODS
  59-year-old male with a history of a previous stroke.
  
  
  RESULTS
  Examination showed an expressive aphasia, word substitution errors, and impaired repetition. A head CT and MRI showed no acute changes. The EEG findings were non-focal and did not show any epileptiform activity. The patient had a history of contact with stray kittens and previous axillary lymphadenopathy. Bartonella henselae serology titers were IgG positive 1:1024 (< 64) and IgM positive 1:20 (< 16). After antibiotic administration, the patient's symptoms and aphasia resolved.
  
  
  CONCLUSIONS
  Focal presentations concerning for stroke or partial seizure activity may have underlying infectious etiology. We recommend consideration of CSD in the differential diagnosis of any adult with a history of lymphadenopathy, fever, and recent contact with a cat who presents with neurologic complications.
authors.affiliation: Departments of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA. carla.marienfeld@yale.edu
authors.forename: Carla B
authors.initials: CB
authors.lastname: Marienfeld
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Dicapua
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Sze
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Goldstein
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001039:Aphasia, Broca / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001474:Bartonella Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology; D018416:Bartonella henselae / Q000302:isolation & purification*; D004569:Electroencephalography; D004660:Encephalitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents