Dermatologic manifestations and update of cat scratch disease.

Cat scratch disease is a relatively common cause of chronic (three weeks or longer) lymphadenopathy, with 80% of cases occurring in children and adolescents. This self-limited infection caused by a small, gram-negative, pleomorphic bacillus has been identified in ocular granuloma, skin inoculation lesions, and lymph node specimens. Dermatologic manifestations observed prospectively in 908 patients included primary cat scratch inoculation papules, pustules or rarely, vesicles. Occasionally, enanthematous mucous membrane (oral, ocular) primary inoculation lesions were observed. About 5% of patients have generalized macular, maculopapular, morbilliform, and rarely petechial, usually nonpruritic exanthem. Rarely, erythema nodosum or multiforme and ecchymoses with petechial rashes are seen. Thrombocytopenic purpura is extremely uncommon. Unusual manifestations such as the oculoglandular syndrome of Parinaud, encephalopathy, or severe systemic disease occur in about 10% of patients. Management consists of symptomatic treatment and occasional aspiration of a suppurative node. The disease usually resolves spontaneously in two to four months.