Department of Internal Medicine, Saitama City Hospital, Saitama, Japan.
Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan; Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
J Infect Chemother. 2022 Nov;28(11):1558-1561. doi: 10.1016/j.jiac.2022.07.013. Epub 2022 Jul 31.
Cat scratch disease (CSD) is an infectious disease caused by Bartonella henselae. CSD follows a typical course, characterized by regional lymphadenopathy. In atypical CSD, the lesions spread to systemic organs and can cause fever of unknown origin (FUO). A previous study showed the usefulness of whole-body magnetic resonance imaging (WB-MRI) with diffusion-weighted imaging (DWI) for limited areas in the diagnosis of FUO, but there are no studies on the clinical utility of whole-body DWI (WB-DWI). We herein report the case of an immunocompetent young man in whom contrast-enhanced CT-unidentifiable multiple liver abscess and osteomyelitis were successfully detected by WB-DWI. Follow-up with a liver biopsy helped confirm an atypical CSD diagnosis.
A 23-year-old previously healthy man was admitted for a 19-day history of high fever despite 3-day treatment by azithromycin. His physical examination was unremarkable and contrast-enhanced CT showed only a low attenuated area in the right lobe of the liver, indicating a cyst. WB-DWI revealed multiple nodular lesions of hypo-diffusion in the liver, spine, and pelvic region. The biopsy specimens of the liver abscess showed no evidence of tuberculosis/malignancy and the polymerase chain reaction (PCR) test of liver abscess aspirate showed positive findings for Bartonellahenselae, confirming the diagnosis of CSD. He completed minocycline monotherapy for a total of 60 days without any deterioration.
WB-DWI can be useful for the diagnosis of atypical CSD with hepatic and bone involvement, which can cause FUO in young immunocompetent adults.
猫抓病（CSD）是由汉赛巴尔通体引起的传染病。CSD 呈典型病程，以区域性淋巴结病为特征。在非典型 CSD 中，病变扩散至全身器官，并可导致原因不明的发热（FUO）。先前的研究表明全身磁共振成像（WB-MRI）结合弥散加权成像（DWI）对有限区域的 FUO 诊断有用，但尚无关于全身 DWI（WB-DWI）临床应用的研究。我们在此报告一例免疫功能正常的年轻男性，其通过 WB-DWI 成功检测到无法通过增强 CT 识别的多发性肝脓肿和骨髓炎。肝活检的随访有助于明确非典型 CSD 的诊断。
一名 23 岁既往健康的男性因阿奇霉素治疗 3 天后仍持续 19 天高热而入院。体格检查无明显异常，增强 CT 仅显示右肝叶有一个低衰减区，提示为囊肿。WB-DWI 显示肝脏、脊柱和骨盆区域存在多个低弥散结节状病变。肝脓肿活检标本未见结核/恶性肿瘤证据，肝脓肿抽吸物聚合酶链反应（PCR）检测结果显示汉赛巴尔通体阳性，确诊为 CSD。他接受米诺环素单药治疗共 60 天，无病情恶化。
WB-DWI 可用于诊断肝、骨受累的非典型 CSD，这可能导致年轻免疫功能正常成年人发生 FUO。
