title: Disseminated cat-scratch disease presenting as nausea, diarrhea, and weight loss without fever in a heart transplant recipient.
abstract: We report the case of an afebrile 59-year-old heart transplant recipient presenting with nausea, vomiting, diarrhea, weight loss, and diffuse lymphadenopathy. Lymph node biopsies revealed non-caseating granulomatous inflammation. Cat-scratch disease was confirmed by serologic studies, Warthin-Starry staining, and polymerase chain reaction testing of lymph node tissue. The patient's symptoms resolved with 3 months of doxycycline. We review clinical presentations of Bartonella henselae infection and review diagnostic approaches for B. henselae in this patient population.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Annukka A R
authors.initials: AAR
authors.lastname: Antar
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Karly
authors.initials: K
authors.lastname: Murphy
authors.affiliation: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Schimmel
authors.affiliation: Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Nisha A
authors.initials: NA
authors.lastname: Gilotra
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Isabella
authors.initials: I
authors.lastname: Martin
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Genevieve Marie
authors.identifier: http://orcid.org/0000-0001-9274-0214
authors.initials: GM
authors.lastname: Crane
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sciortino
authors.affiliation: Division of Infectious Diseases, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Robin K
authors.initials: RK
authors.lastname: Avery
authors.affiliation: Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Houston
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018416:Bartonella henselae / Q000302:isolation & purification*; D001706:Biopsy; D001831:Body Temperature; D009202:Cardiomyopathies / Q000601:surgery*; D002372:Cat-Scratch Disease / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D003967:Diarrhea / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D004318:Doxycycline / Q000627:therapeutic use; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012698:Serologic Tests; D014057:Tomography, X-Ray Computed; D015431:Weight Loss
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D004318:Doxycycline
keywords: Bartonella henselae; gastrointestinal illness; granulomatous inflammation; solid organ transplant