Nakamura Chizuko, Inaba Yuji, Tsukahara Keiko, Mochizuki Mie, Sawanobori Emi, Nakazawa Yozo, Aoyama Kouki
Kofu Municipal Hospital, Kofu, Japan; Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan; Center for Perinatal, Pediatrics and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Japan; Division of Neurology, Nagano Children's Hospital, Azumino, Japan.
Brain Dev. 2018 Feb;40(2):159-162. doi: 10.1016/j.braindev.2017.09.001. Epub 2017 Sep 19.
Cat scratch disease is a common infectious disorder caused by Bartonella henselae that is transmitted primarily by kittens. It typically exhibits a benign and self-limiting course of subacute regional lymphadenopathy and fever lasting two to eight weeks. The most severe complication of cat scratch disease is involvement of the nervous system, such as encephalitis, meningitis, and polyneuritis. Peripheral facial nerve palsy associated with Bartonella infection is rare; few reported pediatric and adult cases exist and the precise pathogenesis is unknown.
A previously healthy 7-year-old boy presented with fever, cervical lymphadenopathy, and peripheral facial nerve palsy associated with serologically confirmed cat scratch disease. The stapedius muscle reflex was absent on the left side and brain magnetic resonance imaging revealed a mass lesion at the left internal auditory meatus. The patient's symptoms and imaging findings were gradually resolved after the antibiotics and corticosteroids treatment.
The suspected granulomatous lesion was considered to have resulted from the host's immune reaction to Bartonella infection and impaired the facial nerve. This is the first case report providing direct evidence of peripheral facial nerve palsy caused by a suspected granulomatous lesion associated with cat scratch disease and its treatment course.
猫抓病是一种由汉赛巴尔通体引起的常见感染性疾病，主要通过小猫传播。它通常表现为良性且自限性的亚急性局部淋巴结病和持续两到八周的发热。猫抓病最严重的并发症是神经系统受累，如脑炎、脑膜炎和多发性神经炎。与巴尔通体感染相关的周围性面神经麻痹罕见；报道的儿童和成人病例很少，确切发病机制尚不清楚。
一名此前健康的7岁男孩出现发热、颈部淋巴结病以及与血清学确诊的猫抓病相关的周围性面神经麻痹。左侧镫骨肌反射消失，脑部磁共振成像显示左侧内耳道有一肿块病变。经抗生素和皮质类固醇治疗后，患者的症状和影像学表现逐渐缓解。
疑似肉芽肿性病变被认为是宿主对巴尔通体感染的免疫反应所致，并损害了面神经。这是首例提供与猫抓病相关的疑似肉芽肿性病变导致周围性面神经麻痹及其治疗过程直接证据的病例报告。
