Begres Jacob M, Mangus Courtney W
Resident Physician, PGY2, University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, USA.
Clinical Lecturer, University of Michigan, Departments of Emergency Medicine and Pediatrics, Ann Arbor, MI, USA.
Am J Emerg Med. 2021 Jun;44:477.e5-477.e6. doi: 10.1016/j.ajem.2020.10.033. Epub 2020 Oct 24.
A 4-year-old girl presented to the emergency department with right leg pain and associated limp for one day. There was no trauma or injury; she had no fever or recent illness. Her exam was notable for tenderness and swelling to the right knee, most prominent in the popliteal region. Initial laboratory testing was unremarkable except for a mildly elevated C-reactive protein. She had normal radiographs of the right lower extremity. A soft tissue ultrasound demonstrated popliteal lymphadenopathy, a rare finding in children. Reassessment of the patient revealed cat flea bites to the leg, which prompted concern for Bartonella henselae infection causing Cat-scratch Disease (CSD). The patient was treated empirically with Azithromycin and her Bartonella titers returned two days later consistent with active infection. This is a rare clinical report describing popliteal lymphadenitis and lower extremity arthropathy caused by Bartonella henselae infection secondary to cat flea bites.
一名4岁女孩因右腿疼痛及伴发跛行一天就诊于急诊科。无外伤史；无发热及近期患病情况。体格检查发现右膝压痛及肿胀，腘窝区域最为明显。初始实验室检查除C反应蛋白轻度升高外无异常。右下肢X线片正常。软组织超声显示腘窝淋巴结病，这在儿童中是罕见发现。对该患者的重新评估发现腿部有猫蚤叮咬痕迹，这引发了对由汉赛巴尔通体感染导致猫抓病（CSD）的担忧。患者接受阿奇霉素经验性治疗，两天后其巴尔通体滴度回报结果与活动性感染相符。这是一篇罕见的临床报告，描述了由猫蚤叮咬继发汉赛巴尔通体感染引起的腘窝淋巴结炎和下肢关节病。
