Infectious Disease Unit, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Infectious Disease Unit, Wolfson Medical Center, Holon, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Infect Dis. 2020 Dec 31;71(11):2818-2824. doi: 10.1093/cid/ciz1137.
Fever of unknown origin (FUO) is a rare manifestation of cat scratch disease (CSD). Data regarding CSD-associated FUO (CSD-FUO), particularly in adults, are limited. We aimed to study disease manifestations and long-term clinical outcome.
A national CSD surveillance study has been conducted in Israel since 1991. Data are obtained using questionnaires, review of medical records, and telephone interviews. FUO was defined as fever of ≥14 days without an identifiable cause. CSD-FUO patients were identified in the 2004-2017 CSD national registry. Follow-up included outpatient clinic visits and telephone/e-mail surveys.
The study included 66 CSD-FUO patients. Median age was 35.5 years (range, 3-88). Median fever duration was 4 weeks (range, 2-9). Relapsing fever pattern was reported in 52% of patients, weight loss in 57%, and night sweats in 48%. Involvement of ≥1 organs occurred in 59% of patients; hepatosplenic space-occupying lesions (35%), abdominal/mediastinal lymphadenopathy (20%), ocular disease (18%), and multifocal osteomyelitis (6%) were the most common. Malignancy, particularly lymphoma, was the initial radiological interpretation in 21% of patients; 32% underwent invasive diagnostic procedures. Of the 59 patients available for follow-up (median duration, 31 weeks; range, 4-445), 95% had complete recovery; 3 patients remained with ocular sequelae.
This is the first attempt to characterize CSD-FUO as a unique syndrome that may be severe and debilitating and often mimics malignancy. Relapsing fever is a common clinical phenotype. Multiorgan involvement is common. Recovery was complete in all patients except in those with ocular disease.
不明原因发热（FUO）是猫抓病（CSD）的罕见表现。有关CSD 相关 FUO（CSD-FUO）的数据，特别是在成年人中，非常有限。我们旨在研究疾病表现和长期临床结果。
自 1991 年以来，以色列一直在进行一项全国性的 CSD 监测研究。数据通过问卷、病历回顾和电话访谈获得。FUO 定义为发热≥14 天，无明确病因。CSD-FUO 患者是在 2004-2017 年 CSD 国家登记处确定的。随访包括门诊就诊和电话/电子邮件调查。
该研究纳入了 66 例 CSD-FUO 患者。中位年龄为 35.5 岁（范围为 3-88 岁）。中位发热持续时间为 4 周（范围为 2-9 周）。52%的患者有反复发作性发热，57%的患者有体重减轻，48%的患者有夜间出汗。59%的患者有≥1 个器官受累；肝脾占位性病变（35%）、腹部/纵隔淋巴结病（20%）、眼部疾病（18%）和多发性骨髓炎（6%）是最常见的。恶性肿瘤，特别是淋巴瘤，是 21%患者最初的影像学表现；32%的患者接受了有创性诊断程序。在 59 名可进行随访的患者中（中位随访时间为 31 周；范围为 4-445 周），95%的患者完全康复；3 名患者仍有眼部后遗症。
这是首次尝试将 CSD-FUO 作为一种可能严重且使人虚弱的独特综合征进行特征描述，且常模仿恶性肿瘤。反复发作性发热是一种常见的临床表型。多器官受累常见。除眼部疾病患者外，所有患者均完全康复。
