title: Visceral cat scratch disease with endocarditis in an immunocompetent adult: a case report and review of the literature.
abstract: Infective endocarditis and hepatosplenic abscesses are rare manifestations of cat scratch disease (CSD), especially among immunocompetent adults. An otherwise healthy woman who presented with fever and abdominal pain was diagnosed with multiple abscesses in the spleen and the liver, as well as a mitral valve vegetation. PCR on spleen tissue was positive for Bartonella henselae. Prolonged treatment with doxycycline and gentamicin led to complete recovery. Review of the literature revealed 18 cases of hepatosplenic CSD in immunocompetent adults; the majority presented with fever of unknown origin and abdominal pain. In most cases the causative organism was B. henselae and the pathological findings were necrotizing granulomas, similar to the pathological features in classic CSD. Concomitant endocarditis was diagnosed in one case. Because Bartonella is one of the leading pathogens of culture-negative endocarditis, we raise the question of whether a comprehensive evaluation for endocarditis is needed in cases of systemic CSD.
authors.affiliation: 1 The Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center , Jerusalem, Israel .
authors.forename: David
authors.initials: D
authors.lastname: Shasha
authors.forename: Dan
authors.initials: D
authors.lastname: Gilon
authors.forename: Fiona
authors.initials: F
authors.lastname: Vernea
authors.forename: Allon E
authors.initials: AE
authors.lastname: Moses
authors.forename: Jacob
authors.initials: J
authors.lastname: Strahilevitz
mesh_terms: D018784:Abdominal Abscess / Q000382:microbiology; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018416:Bartonella henselae / Q000235:genetics / Q000302:isolation & purification*; D002372:Cat-Scratch Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D004318:Doxycycline / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005334:Fever; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D008099:Liver / Q000382:microbiology / Q000473:pathology; D008100:Liver Abscess / Q000382:microbiology; D008875:Middle Aged; D013154:Spleen / Q000382:microbiology / Q000473:pathology; D013158:Splenic Diseases / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000667:Ampicillin; D004318:Doxycycline