title: Cat scratch disease, a rare cause of hypodense liver lesions, lymphadenopathy and a protruding duodenal lesion, caused by Bartonella henselae.
abstract: A 46-year-old woman presented with right upper abdominal pain and fever. At imaging, enlarged peripancreatic and hilar lymph nodes, as well as hypodense liver lesions, were detected, suggestive of malignant disease. At endoscopy, the mass adjacent to the duodenum was seen as a protruding lesion through the duodenal wall. A biopsy of this lesion, taken through the duodenal wall, showed a histiocytic granulomatous inflammation with necrosis. Serology for Bartonella henselae IgM was highly elevated a few weeks after presentation, consistent with the diagnosis of cat scratch disease. Clinical symptoms subsided spontaneously and, after treatment with azithromycin, the lymphatic masses, liver lesions and duodenal ulceration disappeared completely.
authors.affiliation: Department of Gastroenterology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: van Ierland-van Leeuwen
authors.affiliation: Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Peringa
authors.affiliation: Department of Pathology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Blaauwgeers
authors.affiliation: Department of Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Alje
authors.initials: A
authors.lastname: van Dam
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D018416:Bartonella henselae; D002372:Cat-Scratch Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D002415:Cats; D004378:Duodenal Diseases / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D004386:Duodenum / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008099:Liver / Q000382:microbiology / Q000473:pathology; D008107:Liver Diseases / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008206:Lymphatic Diseases / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D007075:Immunoglobulin M; D017963:Azithromycin